Diagnosis

• How is a diagnosis made?
• What breast changes indicate further testing?
• Which doctors are involved in the diagnosis of breast cancer?
• What tests are used in the diagnostic process?
• How do I interpret the results?
• Is there another website which gives further information?
• Are there relevant sections in the Multidisciplinary Care Guidelines for Women with Breast Disease?

There are three pathways to the diagnosis of breast cancer, a woman may:

• be invited to attend for a routine BreastScreen because she is 50 years and over
• self refer for BreastScreen because she is 40 years and over
• present to her general practitioner (GP) with a significant breast symptom. The GP will most likely suggest further diagnostic investigations or refer on to a surgeon
• self refer to a diagnostic breast clinic

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There are a number of breast changes which a woman or her doctor may find throughout a woman's life, such as:

• a breast lump or lumpiness
• breast pain
• change in shape or appearance of the breast such as puckering, dimpling or redness
• nipple discharge (blood stained or watery fluid from the nipple)
• change in shape or appearance of the nipple such as pulling in or scaliness
• an area that feels different from the rest

It is very important that all breast changes are carefully investigated. Most breast changes are NOT due to cancer. If you notice such a breast change then you should see a doctor, either your GP or at a diagnostic breast clinic.

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In the diagnosis process there can be a number of doctors involved, including:

• General Practitioners
• Surgeons
• Radiologists
• Pathologists

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There are a number of tests used in the diagnostic process:

• physical breast examination and history
• diagnostic mammogram
• ultrasound
• biopsy
• nipple discharge smear and Ductogram

During a physical breast examination the doctor asks you about your symptoms and risk factors. The doctor looks for breast abnormalities and changes and examines the lymph nodes in your armpit and above your collarbone. They may also examine the rest of your body for signs of cancer.

A diagnostic mammogram is a low dose x-ray of the breast used for diagnostic purposes. It provides further information about lumps or other breast changes. A diagnostic mammogram mostly takes place at a radiology practice. For further information refer to: Better Health Channel's "Mammography" and "Breast Implants and Mammograms".

An ultrasound uses sound waves to create a picture of your breast (there is no radiation involved). It is a test used to validate a mammogram or physical finding.

A biopsy is performed if there is a significant lump or area of concern in the breast. A biopsy is the removal of a sample of the abnormal area. It is then examined under a microscope by a Pathologist. There are a number of different forms of biopsy:

Fine needle aspiration
A fine needle aspiration is performed in your specialist's rooms or in a hospital outpatient department. A very narrow needle is inserted into the breast tissue and some cells are withdrawn. An ultrasound may be used to help guide the needle. You may notice a little bit of pain when the needle is inserted, but this should pass quickly.
Core biopsy
A needle is used, with local anaesthetic, to take a small core of tissue from the abnormal area / lump in your breast. This needle is larger than the type used in a fine needle aspiration. The doctor may use an ultrasound or x-ray to help guide the needle. You may experience some discomfort and bruising afterwards so you may like to have a support person with you to accompany you home.
Open biopsy
In order to reach a diagnosis, sometimes a small operation is required. The breast lump or abnormality and a clear area of tissue around it is removed under general anaesthetic. This is usually a day procedure in a hospital.

A nipple discharge smear and a ductogram (a special type of x-ray) are tests used for diagnosis when there is a discharge from the nipple.

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How do I interpret the results?

The test results may be either Negative or Positive.

Negative: indicates either no disease or a Benign Condition
Positive: indicates Breast Cancer. Your breast abnormality / lump has been found to be malignant.

If the diagnosis shows no disease then the woman is given the all clear and is recommended to maintain Breast Awareness.

If the test results indicate either a benign condition or breast cancer, the medical treatment team uses these results to assist in the planning of possible treatment pathways.

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Is there another website which gives further information?
For further information refer to The Cancer Council's "How is Breast Cancer Diagnosed?".

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Are there relevant sections in the Multidisciplinary Care Guidelines for Women with Breast Disease?
For a woman about to have an Open Biopsy refer to:

• Patient Care Pathway for Breast Surgery: Day Procedure

For the Health Care Professional refer to:

• Care Pathway for Management of Breast Disease in Women
• Clinical Pathway for Breast Surgery: Day Procedure
• The Role of the GP in the Provision of Care for Women with Breast Disease
• Psychosocial Guidelines for Women with Breast Disease

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