Tests to diagnose early breast cancer

A range of tests may be needed to confirm a diagnosis of early breast cancer. Your doctor will choose the tests needed, depending on your symptoms and any tests you may have already had.

The results of the tests will be used to develop your individual treatment plan, based on your breast cancer diagnosis and personal preferences.

Breast cancer symptoms

Breast cancer can cause a number of signs and symptoms.

Symptoms of breast cancer can include:

changes in the shape or size of the breast
puckering or dimpling of the skin
a rash, generalised redness, scaliness or thickening of the skin
nipple discharge or change in the shape such as it turning inwards
persistent or unusual breast pain
a lump or swelling in the breast or in the armpit.

Checking your breasts regularly and knowing the look and feel of your breast is important. While some breast changes are benign (not cancerous), if you notice any changes in your breast that are new or unusual for you, you should see your doctor as soon as possible.

Some people do not have any symptoms. In some cases, a lump is too small to be felt or cause any changes to the breast and is detected during a routine screening mammogram.

Sometimes a lump may be found during a physical examination by your doctor.

The earlier breast cancer is found, the easier it is to treat and the better the chances of successful treatment.

The free Australian Breast Screening program (that involves having a mammogram every two years) is an effective way of detecting breast cancer early, especially in women aged 50-74.

Tests to diagnose breast cancer

There is a range of tests used to diagnose breast cancer.

It is recommended that doctors use the “triple test” when trying to find the cause of a breast change. This includes:

Physical breast examination and personal history
Imaging tests
Biopsy of the abnormal tissue

Physical breast examination and personal history

If you have noticed a breast change or symptom, your GP will physically examine both breasts. This includes the lymph nodes in your armpits, and the area up to your collarbone. You will also be asked about any family history of breast cancer, as well as any personal history of breast cancer.

Imaging tests

There are several different imaging tests that may be recommended to confirm a diagnosis. These include:

A mammogram which is a low dose X-Ray of the breast. It may be done even if you have already had a routine screening through BreastScreen.
An ultrasound, which uses sound waves, can help determine if a breast lump is solid or filled with fluid. It may be done alone or together with a mammogram to provide more detail.
Magnetic Resonance Imaging (MRI) scan uses a magnetic field and radio waves to produce detailed pictures of soft tissue that may not show up in an X-Ray.

Biopsy

A biopsy is the removal of a tissue sample from the area where a breast abnormality has been detected. The tissue is then sent to a pathologist for review. There are several different methods that can be used. These include:

Core biopsy. Under ultrasound, MRI or mammogram for accurate identification of the affected area of the breast, a needle is used to remove a core (sample of tissue).
Fine needle aspiration (FNA). A fine needle is inserted into the breast, often under ultrasound, to remove a tissue sample.
Vacuum-assisted core biopsy (VAB). A needle that has suction equipment attached, is inserted through a small incision in the skin. A larger amount of tissue can be removed as the needle is able to be rotated. The placement of the needle is usually guided by ultrasound, MRI or mammogram.

Surgical biopsy

Sometimes the results may be unclear from the biopsy. Surgery such as a surgical biopsy (a larger sample of tissue) or wide local excision (removal of the area of abnormal tissue) may be necessary to make a final diagnosis.

Other tests

If cancer is detected in your breast, you may have scans to see if the cancer has spread to other parts of the body such as a CT scan or bone scan.

Other procedures that may help to locate the breast cancer in your breast

Prior to surgery to remove the tissue in your breast that cannot be felt easily, a small procedure to mark the exact area of the breast abnormality may be done to make it easier for the surgeon to find the right spot when they are operating.

A number of different markers can be used to show the area of breast cancer including:

Hookwire localisation

A hookwire is the most common procedure used to mark the area of the tissue that needs to be removed. The wire is called a hookwire because it has a small hook at the end which keeps it in position. The procedure is done just before surgery, in an X-Ray department or private radiology clinic. Ultrasound or mammogram is used to guide the wire to the correct place.

Metal marker

A small metal clip (or marker) can be placed in the breast during a biopsy so that the area can be found again. It can be safely left in the breast and does not need to be removed if no further procedures are needed.

Radioactive seed or magnetic seed

A very low dose radioactive seed or a magnetic seed can be inserted into the breast. During surgery a special probe locates the seed to guide the surgeon to the tissue that needs to be removed. The seed is removed at the same time.

Carbon tracking

Under ultrasound or mammography, a needle is inserted into the breast to the site of the lesion. A small amount of carbon (charcoal suspension) is injected as the needle is withdrawn, leaving a track of carbon. This will direct the surgeon to the tissue that needs to be removed.

Your breast cancer pathology report

The abnormal breast tissue removed from your breast is examined by a pathologist under a microscope and a report is prepared for your doctor.

There are two main types of pathology reports:

an initial biopsy report (confirming whether or not you have cancer)
a breast cancer pathology report (provided after surgery when more specific information about your breast cancer is known).

The information in the pathology report will help you and your doctors decide what treatment will be best for you.

Sometimes your doctor may need further information before recommending a particular treatment plan. If your pathology report shows that you have a particular type of breast cancer, genetic testing may be recommended.

Things you can do now

Visit Cancer Australia for information about breast cancer and the triple test.
Visit Cancer Council to read about tests for breast cancer.
Visit My Journey, BCNA’s online tool for information tailored to your diagnosis. My Journey has a Symptom Tracking tool that you can use to help you record your pain, what works for you and what doesn’t.
Join our Online Network if you think that talking to others online and sharing experiences will help.
Contact BCNA’s Helpline on 1800 500 258 between 9.00 am and 5.00 pm AEST Monday to Friday, for information about the services and support that may be available for you and your family.