Tests and Diagnosis

A process called triple assessment is used to diagnose breast cancer. This triple assessment comprises of three different stages.

1.  Examination.  A doctor or nurse asks about your medical history and examines your breast.

2.  Imaging. It is when pictures are taken to see the tissue inside your breasts using ultrasound or X-rays.

3.  Biopsy. A sample of your breast tissue is removed and sent to a laboratory for testing to determine whether the cells are cancerous (malignant) or not cancerous (benign).

The triple assessment helps your doctor decide if you need any further treatment. The imaging and biopsy stages of the assessment are what we collectively refer to as medical investigations. There are many investigations involved in screening and diagnosing breast cancer. 

Breast Imaging

A picture is taken of the interior of your breasts in order to determine the location of the lump. Not to worry, imaging is usually done by a radiologist (a doctor who specializes in using imaging methods to diagnose medical conditions) or a radiographer (a health professional trained to perform imaging procedures), both professionals trained to make the process as comfortable as possible for you. There are two imaging procedures commonly used, a mammography and an ultrasound.

• A mammogram uses X-rays to create an image of your breast. Mammogram is usually done while you're standing up. Your breast will be pressed between two plastic plates to keep it still. Some women find the pressure of these plates uncomfortable. Keep in mind that if you are over 35 years old and have not had a breast X-ray in the past year, your doctor may arrange to have one performed on you even if no lumps are present. Mammograms can identify abnormalities in your breast but it may not be able to tell you if the abnormality is cancerous or not.

• An ultrasound uses sound waves instead. Your radiologist or radiographer will put gel on your breast and then move a sensor over your skin. This should not be painful although the gel may feel a little cold. While a mammogram is better than ultrasound as a screening test, the advantages of an ultrasound is that it can tell you whether a lump is fluid or solid as well as aid your doctor in judging whether an abnormality is benign or something more serious. 

Breast Biopsy

A biopsy is usually done after imaging if an abnormality is detected in your breast. The sample will be sent to a laboratory for testing to determine whether the cells are cancerous or not.

Do be aware that the biopsy may be performed as a frozen section procedure. In this procedure, the patient is under general anaesthesia and a part of the highly suspicious tissue is removed, frozen with special techniques and sent for microscopic examination. The report is available in a short time. If it is malignant, operative treatment for surgery is undertaken. If not, then the wound is simply closed with stitches. It has the advantage of combining two procedures in one.

A biopsy can be carried out through many methods including fine needle aspiration, core biopsy, vacuum assisted core biopsy and open biopsy. Do discuss with your doctor as to which kind of biopsy is best tailored for your needs.

• In fine needle aspiration, your doctor will collect cell samples from your breast using a fine needle. He or she will pass the needle through the skin of your breast, usually just once, into the lump or breast tissue being examined and draw cells out into a syringe. Sometimes ultrasound or X-rays are used to help guide your doctor to the area that needs to be checked. A fine needle biopsy involves only a small sample of tissue being taken from your breast. If you are given a local anaesthetic, you should not feel any pain.

• During a core biopsy, your doctor will collects breast tissue samples using a hollow needle. Your doctor will pass the needle through your breast to the area to be checked. Then, a spring in the needle will be released and breast tissue will be collected inside the hollow cylinder. The needle may be inserted several times to get more than one sample of breast tissue. Be aware that the spring action is quite sudden and may surprise you the first time. A core biopsy involves removing a larger sample of your breast tissue compared to fine needle aspiration and it can be painful. Your doctor will usually give you an injection of local anaesthetic to help minimize any discomfort. After the effects wear off, you may need some pain relievers.

• In a Vacuum assisted core biopsy (VACB), your doctor will collect breast tissue samples using a special, hollow probe attached to a gentle vacuum pump. After making a small cut in your breast over the area being examined, the vacuum probe will be inserted. The probe will suck some of your breast tissue into a cylinder. One of the advantages of this technique is that more than one sample can be taken without your doctor removing the probe. VACB is useful for removing larger samples of breast tissue and sometimes a whole lump can be removed in this way.

•  In an open biopsy (or excision biopsy), you will be put under general anaesthesia and a minor operation will be done on your breast to remove the entire lump. Therefore, you may need to spend a night in the hospital.

The costs for these procedures can vary greatly depending on many factors. Private health care can easily be multiple times the cost of health care at government hospitals and clinic and do not forget to take into account the fact that if you may be eligible for subsidies from the government. It is impossible to provide definitive figures in this article. Therefore, have a consultation with your health care provider to attain an accurate estimate of what these tests would cost.




References:
1) <http://emedicine.medscape.com/article/263733-overview>
2) <http://hcd2.bupa.co.uk/fact_sheets/html/breast_lump_investigation.html>
3) <http://www.bmj.com/content/335/7615/347.full>