Diagnosing breast cancer

You may be diagnosed with breast cancer following routine breast cancer screening or you may have symptoms which you have seen your GP about.

Seeing your GP

If you notice any of the symptoms of breast cancer, such as an unusual lump in your breast or any change in the appearance, feel or shape of your breasts, it is important to speak to your GP as soon as possible.

Your GP will examine you and, if they think your symptoms need further assessment, refer you to a specialist breast cancer clinic.

The National Institute for Health and Clinical Excellence (NICE) has issued guidance for GPs about referring patients with cancer to specialist services, including a list of symptoms which may require an urgent referral. If you need to be referred urgently, you will usually be seen within two weeks.

If you have suspected breast cancer, either due to your symptoms or because your mammogram has shown an abnormality, you will be referred to a specialist breast cancer clinic for further tests.

Test at the breast cancer clinic

Mammogram and breast ultrasound

If you have symptoms and have been referred by your GP, you will have a mammogram to produce an X-ray of the breasts. You may also need an ultrasound scan. If your cancer was detected through the NHS Screening Programme, you may need to have another mammogram or ultrasound scan.

If you are under 35, your doctor may suggest that you have a breast ultrasound scan only. Younger women have denser breasts, which means a mammogram is not as effective as detecting cancer.

Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts. The image produced will show any lumps or abnormalities that are present in your breasts. Your doctor may also suggest a breast ultrasound if they need to know whether a lump in your breast is solid or contains liquid.

Biopsy

A biopsy involves taking a sample of tissue cells from your breast and testing them to see if they are cancerous. You may also need to have a scan and a needle test on the lymph nodes in your armpit (axilla) to see if these are also affected. Biopsies can be taken in different ways and the type you have will depend on what your doctor knows about your condition. The different methods of carrying out a biopsy are outlined below.

Needle aspiration may be used to test a sample of your breast cells for cancer or to drain a benign cyst (a small fluid-filled lump). Your doctor will use a small needle to extract a sample of cells, without removing any tissue.

Needle biopsy 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 that you have a guided needle biopsy (usually this is guided by ultrasound or X-ray but sometimes MRI is used) to obtain a more precise and reliable diagnosis of cancer and to distinguish it from any non-invasive change, in particular ductal carcinoma in situ (DCIS). 

Treating breast cancer

People with cancer should be cared for by a multidisciplinary team (MDT). This is a team of specialists who work together to provide the best treatment and care.

The team often consists of a specialist cancer surgeon, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, pathologist, radiographer, reconstructive surgeon and a specialist nurse. Other members may include a physiotherapist, dietitian and occupational therapist, and you may have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

You can discuss your treatment with your care team at any time and ask any questions.

The main treatments for breast cancer are:

You may have one of these treatments or a combination. The type of treatment or the combination of treatments will depend on how the cancer was diagnosed and the stage it is at. Breast cancer that has been diagnosed at screening may be at an early stage, but breast cancer diagnosed when you have symptoms may be at a later stage and require a different treatment. Your healthcare team will discuss with you which treatments are most suitable.

Surgery

There are two types of surgery for breast cancer. These are surgery to remove just the cancerous lump (tumour), known as breast-conserving surgery, and surgery to remove the whole breast, which is called a mastectomy. In many cases, a mastectomy can be followed by reconstructive surgery to recreate the breast that was removed.

Studies have shown that breast-conserving surgery followed by radiotherapy is as successful as total mastectomy at treating early-stage breast cancer.

Breast-conserving surgery

Breast-conserving surgery ranges from a lumpectomy or wide local excision (WLE), in which just the tumour and a little surrounding breast tissue is removed, to a partial mastectomy or quadrantectomy, in which up to a quarter of the breast is removed.

If you have breast-conserving surgery, the amount of breast tissue you have removed will depend on:

Your surgeon will always remove an area of healthy breast tissue around the cancer, which will be tested for traces of cancer. If there is no cancer present in the healthy tissue, there is less chance that the cancer will recur. If cancer cells are found in the surrounding tissue, you may need to have more tissue removed from your breast.

After breast-conserving surgery, you will usually be offered radiotherapy to destroy any remaining cancer cells.

Mastectomy

A mastectomy is the removal of all the breast tissue, including the nipple. If there are no obvious signs that the cancer has spread to your lymph nodes, you may have a mastectomy, in which your breast is removed, along with a sentinel lymph node biopsy (SLNB).

If the cancer has spread to your lymph nodes, you will probably need more extensive removal (clearance) of lymph nodes from the axilla (under your arm).

How common are mastectomies?

In 2009-2010, nearly 18,000 mastectomies where carried out in the UK. A further 39,000 women had other types of breast surgery, such as lumpectomies.

Reconstruction

Breast reconstruction is surgery to make a new breast shape that looks as much as possible like your other breast. Reconstruction can be carried out at the same time as a mastectomy (immediate reconstruction) or it can be carried out later (delayed reconstruction). It can be done either by inserting a breast implant or by using tissue from another part of your body to create a new breast. 

Lymph node surgery

To find out if the cancer has spread, a procedure called a sentinel lymph node biopsy (SLNB) may be carried out. The sentinel lymph nodes are the first lymph nodes that the cancer cells reach if they spread. They are part of the lymph nodes under the arm (axillary lymph nodes). The position of the sentinel lymph nodes varies, so they are identified using a combination of a radioisotope and a blue dye.

The sentinel lymph nodes are examined in the laboratory to see if there are any cancer cells present. This provides a good indicator of whether the cancer has spread.

If there are cancer cells in the sentinel nodes, you may need further surgery to remove more lymph nodes from under the arm.