Diagnosis of Breast Cancer
A conclusive, definite diagnosis of Breast cancer can only be made after a confirmed biopsy report.
In case you find a suspicious change during a routine BSE, the steps to be followed are:
On your regular monthly BSE if you find any change ( click here for details) it needs to be checked out on a priority basis.
Step 1 : Reach out to your primary physician (family doctor).
The doctor may find that the problem you are facing does not require further investigation.
However you must continue the practice of regular BSE.
If the doctor finds the problem needs further investigation, a Sonography of the breast will be advised.
Step 2 : Ultrasound/Sonography: This test uses sound waves. There is no radiation involved. Therefore it is harmless and safe for women in the childbearing age group and pregnant women. It is a painless procedure. Jelly is applied on the skin for good contact and the examination may take about15-20 minutes. With this examination it is possible to distinguish solid masses from cystic ones. Cysts are usually benign. Appearance, outline, presence of calcification in the mass if solid. can give an indication of the nature, whether malignant or benign. Lymph nodes if enlarged can also be easily detected on ultrasound and give an indication to the nature of the problem.
If the sonography indicates a possibility of malignancy, Mammography is advised.
Step 3 Mammogram: This a very sensitive test for picking up malignancy early, particularly microcalcifications which occur very early in breast cancer. However as this examination involves exposure to radiation it is not advised routinely. It is avoided in women in the childbearing age group & pregnant women. It cannot distinguish between cysts and solid masses.
A mammogram report will contain certain details. Most important are the breast composition and the BIRADS classification.
The breast composition indicates the kind of tissue present in the breast. A,B,C,D- where A is Fatty and D is Dense.
BIRADS Classification indicates the mammographic findings . 0-6
0 is negative for cancer waiting to check earlier reports or additional investigations.
1 is normal
2 is benign -there is a mass which is not cancer
3 is mostly benign but follow-up advised after 6 months
4 is mostly cancer but needs biopsy
5 is cancer to confirm on biopsy
6 is presence of cancer which is on follow-up to check status
If the Mammography report indicates suspicion of malignancy, the next step advised is a Biopsy which is done under Sonographic guidance.
Step 4 : Biopsy: This helps to confirm the exact nature of the tumor whether benign or malignant. Also will identify the type of breast cancer. The biopsy report will indicate various parameters. Different breast cancers arising from different tissues have different qualities. Some are more aggressive than others, spreading quicker. The treatment for various types also differ. Some are responsive to hormone therapy and so on.
Confirmation of breast cancer & treatment can only be initiated once the exact nature of the tumor is identified on the biopsy.
In 80% of cases there is no malignancy.
However, in 20% of cases there is!
As the incidence of breast cancer is so high,
it is safer to err on the side of safety.
Newer methods are being devised to identify breast cancer early. Some are based on Thermal Imaging with Artificial Intelligence inputs. These will make early detection more accessible, accurate and cost effective.