Breast Cancer Diagnosis

Breast Cancer Diagnosis: Getting it Right – Right From the Start

Getting the right diagnosis means getting the right testing, which guides treatment decisions and ultimately, better survival. Second opinions are important in cancer care, and the best way to ensure your initial diagnosis is accurate and the treatment recommendations are best for you. If you come to Roswell Park for a second opinion, you are under no obligation to receive care or treatment here.

Standard Diagnostic Procedures

Dr. Bonaccio explains the selective process of choosing the best state-of-the-art equipment and technology to diagnose and treat breast cancer.

Thanks to widespread breast cancer screening through use of mammography (X-ray of the breast), many breast cancers are found at an early stage and long before they would have caused any warning symptoms. Routine mammography saves lives, reducing a woman’s risk of dying from breast cancer by about 30 to 50 percent.

Roswell Park recommends women have an annual screening mammogram beginning at age 40. Having different risk factors may indicate a need for frequent or different testing. Learn whether you should have a different screening regimen at our Breast Cancer Risk Assessment & Prevention Program.

Abnormal Mammogram or Exam?

If your mammogram or physician’s exam suggests an abnormality, or if you have symptoms (such as a lump) you may have one or more of the following additional tests:

  • Diagnostic mammography: This type of mammogram takes x-rays of the breast from additional viewpoints and can focus more closely on the area of concern.
  • Ultrasound exam: Ultrasound, which uses sound waves to create a picture of the inside the breast, can determine whether a lump is a benign cyst or a solid mass, and can guide needle biopsy. (Women younger than age 30 who have a palpable lump will likely have an ultrasound first.)
  • Magnetic resonance imaging (MRI): Uses radio waves and a powerful magnet to create a picture of the breasts.
  • Biopsy: Taking samples of the suspicious tissue to examine under a microscope can be done in one of these ways:
    • Hollow core needle biopsy: a wide needle extracts tissue sample
    • Fine needle aspiration: a thin needle extracts tissue or fluid
    • Excisional biopsy: surgery to remove the entire lump of tissue

It is almost always preferred to have a needle biopsy before any surgery is done – and needle biopsy can be done in most women.

After a Biopsy

If the biopsy is negative (shows no sign of cancer), you may resume your normal mammography schedule. Other imaging tests are generally not necessary. In some cases, especially with a larger cancer, additional tests such as CT or other scans may be ordered to learn more about your cancer. For most women, however, this is not necessary for two important reasons:

1. A scan cannot determine whether the cancer has spread in microscopic amounts
2. A negative scan does not change the treatment plan, such as whether chemotherapy or other treatments are necessary

In women with large cancers, with many involved lymph nodes, or with worrisome symptoms, additional testing may include: