The Breast Cancer Diagnosis Process: From First Visit to Biopsy

When a finding is noticed in the breast, the road to a result is actually systematic. The approach called triple assessment is the shared standard of the world’s leading breast centres: clinical examination + imaging + biopsy.

1. History and clinical examination

You are asked when the complaint started, its relation to your periods, family history, medicines and previous breast conditions. Both breasts, the underarm and the collarbone area are examined carefully.

2. Imaging

• Mammography: usually the first choice at age 40 and over.
• Ultrasound: first choice in younger women and dense breasts; very valuable for telling cyst from solid.
• MRI: in selected cases, to look for extra foci or for surgical planning.

Imaging findings are reported with the BI-RADS classification: 1–2 normal/benign, 3 probably benign (short-interval follow-up), 4 suspicious (biopsy), 5 very high probability of cancer (biopsy).

3. Biopsy

In a suspicious focus the diagnosis is made by needle biopsy: under ultrasound or mammography guidance, with local anaesthesia, a tissue sample is taken through a thin needle; no operation is needed. If a lymph node looks suspicious, it can also be sampled when necessary. After the biopsy a small marker clip may be placed in the area, which is very helpful for later treatment planning.

4. The pathology report: what is looked at?

• Type: invasive ductal, lobular, DCIS and so on.
• Grade: how fast the cells are multiplying.
• Oestrogen and progesterone receptors: tell whether hormone therapy will work.
• HER2: determines response to targeted therapies.
• Ki-67: an indicator of the rate of proliferation.

While you wait

Waiting for the result is the hardest stage. It is also common for a biopsy result not to be cancer; most lumps are benign. Whatever the result, discussing it and the next step face to face, coming with someone from your family and preparing your questions in writing makes the process easier.