Breast cancer

Diagnosis and tests

Diagnosing breast cancer

Your family doctor (GP) will talk to you about your symptoms and will examine your breast area. They will refer you to a breast clinic if they think you need more tests. This doesn’t mean you have cancer. Remember, 9 out of 10 breast lumps are harmless. 

Questions to ask your doctor about breast cancer tests

If your doctor refers you for tests, ask:

  • Why are you referring me for tests?
  • Can I be referred to a specialist breast clinic?
  • How quickly will I be seen?
  • Is my referral urgent or non-urgent?
  • Which tests will I need and why? 
  • Ask about triple assessment. Triple assessment is when you have 3 tests: a physical examination, a mammogram / other scans, and a core biopsy or fine needle aspiration. 

If your doctor does not refer you for tests, ask:

  • Can you explain why you’ve decided not to refer me to a breast specialist?
  • How can you be sure I don’t have breast cancer?

Tests you might have include:

Mammogram: An X-ray of your breast

Ultrasound scan: A device like a microphone passed over your breast that can produce an image of the inside of your breast and show any lumps. 

Biopsy: Taking a sample of cells. Biopsies are sent to a laboratory and looked at under a microscope to find out if cancer cells are present.

There are different ways to get breast tissue samples: 

  • Fine needle aspiration: Your doctor uses a fine needle and syringe to take a sample of cells. 
  • Needle (core) biopsy: Your doctor or nurse uses a hollow needle to take the sample.
  • Wire guided biopsy: A fine wire is inserted into your breast to help guide the surgeon to the area to be removed. It is used if no lump can be felt or it’s hard to pinpoint the exact area in your breast which needs to be removed. 
  • Punch biopsy: This means taking a sample of cells using a tool that can take a small disc of skin from your breast. The area will be numbed with a local anaesthetic. You may have an ultrasound scan to show where to take the sample from. You may have a punch biopsy if you have changes to the skin on your nipple or if your breast is red or inflamed, as a mammogram might be painful for you. 

This is a scan that uses sound waves to look at the lymph nodes in the area of your armpit (axilla). The scan is done in the X-ray department of the hospital. The scan is painless and only takes a few minutes. If the lymph nodes look abnormal, a biopsy (tissue sample) will be taken to see if the cancer has travelled to the lymph nodes.

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If you are diagnosed with breast cancer, we're here for you. 
Our cancer nurses are here if you need information or just want to talk. They can help you to understand your diagnosis and what to expect, send you information and tell you about our services. 

Further tests for breast cancer

You may need further tests to give your doctors more information about your general health and about the cancer.  For example:

This is a scan that uses sound waves to look at the lymph nodes in the area of your armpit (axilla). The scan is done in the X-ray department of the hospital. The scan is painless and only takes a few minutes. If the lymph nodes look abnormal, a biopsy (tissue sample) will be taken to see if the cancer has travelled to the lymph nodes.

Blood tests can check your general health, for example, to make sure you're fit for surgery. Blood tests can also give information about your liver and bones. You may need an X-ray or scans if your blood tests show any abnormal changes. 

X-rays can check for bone and other joint problems. X-rays can also show changes in tissues and organs, such as the breast. You may have a chest X-ray to check you are fit for surgery. You may need a spine X-ray if you're having back pain.

A scan that uses magnetic energy to build up a picture of the tissues inside your body. During the scan you will lie inside a tunnel-like machine. Find out more about MRI scans.

A type of X-ray that gives a detailed picture of the tissues inside your body. Usually the scan will be of your chest, abdomen and pelvis. More about CT scans.

A radioactive injection that can show areas of abnormal bone on a scan, which may be caused by cancer that has spread.

Bone scan.

A device like a microphone passed over your tummy to give a picture of your liver so your doctor can see any changes to your liver.

Ultrasound scan of the liver

This means taking and testing a sample of cells from the lymph nodes to see if they contain cancer cells. It't important to know this, as it will influence the type of treatment you need. This will be done before surgery if the lymph nodes look abnormal on a scan.  Your surgeon may also remove lymph nodes during breast cancer surgery.

Lymph node biopsy

The tests you have can help to:

  • Stage your cancer. This means finding out the size and position of the cancer.
  • Grade your cancer. Grading describes how quickly the cancer may grow and spread and how it might respond to treatment.

Some tests may be used see how you are responding to treatment. 

Testing breast cancer cells

In breast cancer, some receptors mean that hormones will encourage the cancer cells to grow (hormone-receptor positive cancer). Breast cancer cells can also have too many HER2 protein receptors. HER2 can encourage breast cancer to grow. 

Samples of your cancer cells (biopsy) will be tested to give your doctors more information about receptors, to help them plan the best treatment for you.

You may also have a test called Oncotype DX. This gives information about how your cancer might grow and if you're likely to benefit from chemotherapy.

Read more about breast cancer, hormones and proteins.

Waiting for test results

While some results may come back quickly, others may take a few weeks. Waiting for results can be an anxious time. It may help to talk things over with your doctor or nurse or with a relative or close friend. You can also call our Support Line on 1800 200 700 or visit a Daffodil Centre to speak to a cancer nurse.

What are the stages of breast cancer?

Staging means finding out how big the cancer is and if it has spread to other parts of your body. Staging will help your doctor to plan the best treatment for you. 

TNM staging system

The staging system normally used is called TNM. This stands for:

N0 means no lymph nodes are affected.

If the cancer has spread to the lymph nodes (positive lymph nodes) the N will have a number to describe how many lymph nodes are affected. 

NX means the doctors cannot tell if the nodes are affected.

M1 means the cancer has spread (metastasised) to other organs. 

M0 means it hasn't.

Number staging

Your doctor often uses the TNM information to give your cancer a number stage – from 1 to 4.  A higher number means a more advanced cancer. 

  • Stage 0: Non-invasive breast cancer, e.g. DCIS
  • Stage 1: The cancer is found only in your breast
  • Stage 2: The cancer is found your breast and nearby lymph nodes
  • Stage 3: The cancer has spread to more lymph nodes
  • Stage 4: The cancer has spread to other organs in your body. This is called metastatic breast cancer

What are the grades of breast cancer?

Breast cancer cells can be graded as 1, 2 or 3, depending on how different they are to normal breast cells and how quickly they are growing. The grade gives your doctor information about how quickly the cancer may grow and spread. 

In general, grade 1-2 means a slower growing cancer and grade 3 is faster growing. 

Knowing the stage and grade of your cancer helps your team to plan the best treatment for you.

Staging and grading can be hard to understand, so ask your doctor and nurse for more information if you need it.


Continue reading about breast cancer

Read next Breast cancer treatment

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