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Diagnosis of Breast Cancer

Early Detection of Breast Cancer

In this issue of the Health Gazette I am going to reproduce a patient handout that was developed by The Florida Task Force on Early Diagnosis of Breast Cancer and produced by The Florida Academy of Family Physicians in conjunction with the Florida Early Diagnosis Steering Committee. I think this handout is very informative. Breast cancer is one of the more curable forms of cancer if it is caught early. If you have a breast lump, it is important to pursue a diagnosis even if the mammogram is normal. Up to 20 percent of breast cancers do not show up on mammograms. The patient information handout is included in its entirety below.

Understanding Breast Lumps and Other Changes

Breast changes are a common event. They include those that normally occur during the menstrual cycle and pregnancy, as well as with aging. Most breast lumps - eight out of ten - are not cancer, but only a doctor can tell whether or not a condition is malignant (cancer) or benign (not cancer). This handout explains how your doctor will evaluate your breast lump and other breast changes.

A look inside the breast...
The breast consists of glandular tissue, fatty tissue, and fibrous tissue. Each breast has 15-20 sections, called lobes, each with many smaller lobules. The lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are all linked together by thin tubes called ducts.

What could be causing the lump or other changes?

Occasionally the breast feels lumpy, but this is normal. Many women experience swelling, tenderness, and pain before(and sometimes during) their periods. Every woman should become familiar with how her breasts feel by doing breast self-examination (BSE).

The following are some of the conditions the doctor will be considering:

1. Fibrocystic Changes - general breast lumpiness, which is benign.

2. Cysts - fluid-filled sacs. They occur most often in women 35-50 years of age. The cysts often enlarge and become tender just before a woman's menstrual period. Cysts are usually handled by observation or by withdrawing fluid with a small needle.

3. Fibroadenomas - benign masses of tissue that do not contain fluid.

4. Cancer - when cells grow without control or order.

Breast pain - is it serious?
Breast pain is very common in premenopausal women. The pain can be shooting to the nipple, burning, itching, or aching. One breast may hurt more than the other. Usually it starts two weeks after menstruation and gets worse until the beginning of your period. It gets better for two weeks, then the cycle starts over. Breast pain is more common in women in their 30s and 40s, and lessens after menopause. If you have pain or soreness with a lump or redness, you should call your doctor immediately.

How does the doctor evaluate the lump or other breast changes?
Your physician will evaluate your breast changes using a combination of a breast examination, mammography, ultrasound, and/or biopsy. Although no one of these procedures is 100% accurate, when combined they will usually diagnose your condition correctly. Therefore, you, your personal doctor, your radiologist, and your surgeon need to work together as a team.

What is mammography?
A mammogram uses a weak Xray to take pictures of the breast. The breast is compressed between two plastic plates and two x-ray pictures are made of each breast. The mammogram is read by a radiologist who will give you and your physician the results. A mammogram is 85-90 % accurate. Therefore, 10-15 % of cancers cannot be seen by mammogram.

There are two types of mammograms:

1. Screening Mammogram - for women without a breast problem(every woman over the age of 40 should have a screening mammogram on a regular basis).

2. Diagnostic or Complete Mammogram - for women with a lump or other breast concern.

Some women worry about the effects of radiation from a mammogram. Nowadays, the amount of radiation received is less than what we get from a chest Xray. A mammogram can cause some discomfort due to compression of the breast. If a woman has tender breasts, it is best to have the mammogram done after menstruation when the breasts are less tender.

What is ultrasound?
Ultrasound is used for women under 30 years old, or as a complement to mammography. It is used if a mammogram shows a change that needs to be diagnosed as a real mass or fibrosis. If it is a real mass, ultrasound can distinguish a benign cyst from a solid mass that may need to be biopsied. Also, ultrasound is used when the mammogram is normal, but an abnormality is detected through a physical examination.

What is a biopsy?
Often, the best way to find out the cause of your condition is to have a small piece of tissue removed from the breast and sent to the laboratory to be examined under a microscope. There are four types of biopsies:

1. Fine Needle Aspiration - a thin needle is inserted into the suspect tissue and some cells are removed.

2. Core Biopsy - a larger needle removes a small piece of tissue.

3. Incisional Biopsy - a surgeon removes only a slice or wedge of the suspicious area.

4. Excisional Biopsy - the surgeon removes the entire lump and some of the surrounding tissue.

A final word...
Breast lumps and changes can be frightening. Remember that most lumps and changes are normal, and often disappear on their own. Every lump that does not go away on its own, or is not filled with fluid needs to be further evaluated. Some lumps and changes are more difficult to diagnose, and require several tests. It may take several weeks to reach a final diagnosis. Waiting for the results causes anxiety, but is the best way to avoid unnecessary surgery.

Alert the doctor to changes you notice in your breasts, and be sure to follow the doctor's recommendations for follow-up procedures. You should be advised of all test results, and feel free to ask any questions you have.

The information provided above is offered as a community service about health-care issues and is not a substitute for individual consultation. Advice on individual problems should be obtained from your personal physician.

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Readers may send questions to our email address. This column is for informational purposes only and is not a substitute for professional or medical advice.

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