Breast Cancer: Diagnosis
1. Breast physical exam
A breast physical exam should be performed by a doctor or a qualified professional and should be done at least once every three years. This test is different from the self exams as unless one is experienced or qualified, it is usually difficult to detect small lumps and changes in the breast. In fact, many a times a tumor may go unnoticed in a mammogram, but a physical test might detect it. A physical test is usually succeeded by a confirmatory test.
The mammogram is one of the oldest diagnostic tests for detecting breast cancer and is reasonably accurate as well. Here, an x-ray of the breasts is done to detect any abnormality. Screening mammograms are performed initially to detect any lump or formation in the breasts. After that, a diagnostic mammogram is done to further evaluate the condition and to monitor the lump during treatment.
3. Breast ultrasound
In the ultrasound test, sound waves are sent through your breasts and an image is generated. This test is usually done in conjunction with other diagnostic tests like a mammogram. The ultrasound test cannot detect whether a lump is cancerous or not, but it is the best way to determine if the lump is solid or fluid filled. No radiation is involved in this test.
4. Blood marker tests
Cancerous cells release specific proteins into the blood stream which can be detected by blood marker tests. These tests are also used to determine whether the cancer is spreading to other organs in the body. Though these tests are promising they are not entirely conclusive and are expensive too.
5. Digital tomosynthesis
Where a mammogram takes a 2-D x-ray of the breast, a digital tomosynthesis generates a three dimensional image. The mammogram test is uncomfortable as the breast is pressed against a plate and an x-ray is taken. This might also cause overlapping of the breast tissue giving false results. But in a tomosynthesis, just enough pressure is applied to keep the breast stable, and several images are taken. This 3-D model reduces the chances of missing any tumor.
6. Ductal lavage
This test is a newer technique where pressure is applied to the nipple to remove fluid from the milk ducts present in the breast. A tiny metal tube is placed in one of the milk ducts and pressure is applied. This causes the fluid to enter the tube. The tube is then removed and the fluid is tested for the presence of cancer cells. This test can only detect the presence of cancer, but cannot give the actual location of the tumor. For that, tests like biopsies need to be performed after the ductal lavage test.
The thermography test is a non invasive test which uses a special camera to measure the temperature of the skin on the breast. Thermography is based on the idea that as cancer cells multiply rapidly, blood flow and metabolism increases, in turn increasing the temperature of the breast.
Biopsy is a confirmatory test where a tissue sample from the breast is removed and is tested for cancer. The biopsy test is an invasive test and though your surgeon will try to use the least invasive procedure, it depends on your situation and how far the disease has progressed. There are several biopsy techniques. The ‘fine needle aspiration biopsy’ and the ‘core needle biopsy’ are the least invasive tests, where a needle is inserted into the area to remove a tissue sample. Though these tests do not leave a scar, there is a chance of ‘false negative’, that is a cancer might go unnoticed. The ‘incisional’ and the ‘excisional’ tests are invasive tests and are like surgical procedures, where a scalpel is used to cut through the skin to remove a tissue sample. In the ‘excisional’ test, the entire cancerous tissue is removed.
9. PET scans
In this test a radioactive material made of sugar is injected into the breasts. The cancerous cells being more active than healthy cells absorb this material. When the breasts are scanned, the cancerous cells are highlighted on a computer screen. The PET scan test is very expensive and is a conclusive test with very small chances of error.