Embarrassing Illnesses

See your GP if you notice a lump in your breast or any change in the appearance, feel or shape of your breasts. Your GP will examine your breasts and, if they think you may have breast cancer, they will refer you to a specialist breast clinic for tests.

At the breast clinic, a specialist or breast nurse will carry out tests to determine whether or not you have breast cancer. If you have breast cancer, the tests will also show what type of breast cancer you have. Your specialist or nurse will determine the best way to treat you. They may take photographs of your breasts to keep a record of their current appearance and any further changes which may occur.

If you are diagnosed with breast cancer, the tests can also identify the stage and grade of the cancer, which your oncologist (specialist in cancer) will discuss with you thoroughly. The stage describes how far the cancer has spread at the time of diagnosis and the grade indicates how aggressively it is spreading.

Determining the stage and grade of your breast cancer will help your doctors to decide on the best treatment. However, the stage and grade alone cannot predict how your condition will progress, which also depends on factors such as the type of breast cancer and your overall health.

The tests you may have to diagnose breast cancer and those which determine specific types of treatment are outlined below.

Blood test

A sample of your blood will be taken so that your doctor can assess your overall health, as well as how well your liver and kidneys are working.

Mammogram

A mammogram is a simple procedure that uses X-rays to create an image of the inside of your breasts. It can identify early changes in your breast tissue, when it may be difficult to feel a lump. Younger women usually have denser breasts in which changes are more difficult to identify, so a mammogram is not as effective in women under 35. In this case, your doctor may suggest that you have a breast ultrasound instead.

If you need to have a mammogram, your radiographer (X-ray specialist) will position one of your breasts on a flat X-ray plate. A second X-ray plate will press down on your breast from above, so that it is temporarily compressed and flattened between the two plates. An X-ray will then be taken, which will give the clearest possible image of the inside of your breast. The procedure will then be carried out on your other breast.

You may find it a bit uncomfortable or even a little painful, but it only takes a few minutes. Your doctor will examine the mammography for indications of cancer, such as calcification (areas of calcium within your breast tissue that show up on the X-ray). If you have calcification, it does not mean that you have cancer. You will need further tests to confirm a diagnosis.

Breast ultrasound

You may need to have a breast ultrasound if you are under 35 because your breasts may be too dense for a mammogram. Your doctor may also suggest a breast ultrasound if they need to know whether a lump in your breast is solid or contains liquid.

Ultrasound uses high-frequency soundwaves to produce an image of the inside of your breasts (in the same way that ultrasound can show an unborn baby in the womb). An ultrasound probe, or sensor, will be placed over your breasts to create an image on a screen. The image produced will show any lumps or abnormalities that may be present in your breasts.

Biopsy

A biopsy involves taking a sample of tissue cells from your breast and testing it to see if they are cancerous. Biopsies can be taken in different ways and the type you have will depend on what your doctor knows about your condition so far. The different methods of performing a biopsy are outlined below.

• Needle aspiration. This type of biopsy may be used to test a sample of your breast cells for cancer or to drain a benign cyst (small fluid-filled lump). Your doctor will use a small needle to extract a sample of cells without removing any tissue.
• Needle biopsy. This is the most common type of biopsy. A sample of tissue is taken from a lump in your breast using a large needle. You will have a local anaesthetic, which means that you will be awake but your breast will be numb. Your doctor may suggest a needle biopsy if they need to know whether the cancer has spread, as it allows them to examine the cells in place within the piece of breast tissue that has been removed.
• Surgical or excision biopsy. This type of biopsy is carried out under general anaesthetic, which means that you will be asleep during the procedure. Your doctor will surgically remove all or part of a lump from your breast to test it for cancer.

CT scan or MRI scan

CT and MRI scans produce detailed pictures of the inside of your body. If necessary, they can be used to highlight the areas in your body where cancer has spread. They can also show in detail the exact size and shape of a lump inside your breast.

A CT scan uses a series of X-rays to form a three-dimensional image. An MRI scan uses a strong magnetic field and radiowaves, and your doctor may suggest it if your mammogram or breast ultrasound do not show a lump in your breast in enough detail.

Chest X-ray

You may need a chest X-ray if your doctor thinks your breast cancer may have spread to your lungs.

Bone scan

You may need a bone scan if your doctor thinks the cancer may have spread to your bones. Before a bone scan, a substance containing a small amount of radiation, known as an isotope, will be injected into a vein in your arm. This will be absorbed into your bone if it has been affected by cancer. The affected areas of bone will show up as highlighted areas on the bone scan, which is carried out using a special camera.

The radioactive substance will disappear from your body after a few hours and will not make you radioactive. The amount of radiation used is very small and has no harmful effects. However, as with any form of radiation, there is a small risk of it affecting an unborn child, so avoid contact with pregnant women for the rest of the day if possible.

Tests to determine specific types of treatment

If you are diagnosed with breast cancer, you will need to have further tests which can show whether or not the cancer will respond to specific types of treatment. The results of your tests can give your doctors a more complete picture of the type of cancer that you have and how best to treat you.

Hormone receptor test

In some cases, breast cancer cells are stimulated to grow by hormones that occur naturally in your body, such as oestrogen and progesterone. If this is the case, the cancer may be treated by stopping the effects of the hormones or lowering their levels in your body. This is known as hormone therapy.

A sample of cancer cells will be taken from your breast and tested to see if they respond to either oestrogen or progesterone. The cancer cells are said to respond if they have areas that let either hormone attach itself to them. These are known as hormone receptors.

If you have cancer cells that respond to oestrogen, the type of breast cancer that you have is said to be oestrogen-receptor positive. If the cancer cells respond to progesterone, the cancer is progesterone-receptor positive. Hormone therapy is most effective on cancers that are oestrogen-receptor positive, but this is only one of the ways that breast cancer can be treated.

HER2 test

While some types of breast cancer are stimulated to grow by hormones, other types are stimulated by a protein called HER2. These types of cancer may be treated by blocking the effects of HER2. This is known as biological therapy.

If the test shows that the cancer cells in your breast respond to HER2, it means that they have HER2 receptors (areas that let HER2 attach itself to them). This type of cancer is said to be HER2 positive.

Biological therapy can be used on breast cancers that are HER2 positive but, as with hormone therapy, biological therapy is only one of the ways in which breast cancer can be treated.