Breast cancer screenings have improved greatly over the years, but the experience of getting screened can be confusing to women who aren’t familiar with the process–especially if something suspicious is found.
Breasts are complicated, says Donna Bosch, BSN, RN, OCN, CBCN, a breast cancer navigator at ProMedica Cancer Institute. That’s why many tests are needed before a diagnosis can be made.
The first step may start at your doctor’s office, when a regular clinical breast exam is performed by your doctor. But for many women, the process begins with a mammogram, which may detect a change in your breast before you can even feel it.
A digital mammogram uses X-ray images of your breast to display and record high definition images on a computer monitor. Breast tomosynthesis, or 3D Mammography, allow doctors to examine breast tissue layer by layer, rather than a “flat” image of the breast. “This gives the radiologist more info and reduces the number of false negatives,” says Bosch.
If the mammogram finds something suspicious in your breast, the next step may be a breast ultrasound.
“The ultrasound lets us target areas of concern either found on the mammogram or by the patient herself – or himself; men get breast cancer, too,” Bosch explains. During the ultrasound, a wand-like device called a transducer is placed over your skin. It sends out sound waves that bounce off your breast tissue and makes a picture of the inside of your breasts.
“It uses sound waves to let us know if a mass is solid or liquid,” says Bosch. If the mass is liquid, it may be a cyst filled with fluid. If it’s solid, it may be a tumor.
A biopsy is then done using either the ultrasound or a mammogram to guide the radiologist to the precise area of concern. During the biopsy, a small amount of breast tissue is removed and sent to the lab for evaluation to see if cancer or any other abnormal cells are present.
During the biopsy, a clip is placed in the breast where the biopsy was taken to mark the area where the breast tissue was removed. Bosch explains that this allows the radiologist to keep an eye on that area in the future, or it guides the doctor to the correct area if surgery is needed.
When the biopsy is finished, another mammogram is done to “make sure the clip we put in is in the correct place,” Bosch says.
MRI or MBI
If the biopsy shows the mass is cancerous, the patient might be asked to return to the center for a magnetic resonance imaging (MRI) of the breast. “The MRI uses magnets to image the breast. It gives more detailed information inside of the breast, including the tumor size and the nearby lymph nodes,” Bosch explains.
For women with particularly dense breast tissue, the molecular breast imaging scan (MBI) might be recommended. The MBI uses a radioactive tracer, which is shot in the arm, that concentrates in areas of concern in the breast, Bosch says. “Mammograms are harder to interpret with very dense breast tissue so the MBI may be recommended as an additional test to rule out a tumor.”
Yes, this is a lot of testing, Bosch acknowledges. However, many of the tests can be performed on the same day, one after the other, to help speed up the process of getting a diagnosis, says Bosch. “This gets the patient on the road to recovery that much quicker.”
Breast cancer navigators, such as Bosch, also play an important role in helping patients through the process of breast cancer diagnosis and treatment.