Your doctor can check for breast cancer before you have any symptoms. During an office visit, your doctor will ask about your personal and family medical history. You'll have a physical exam. Your doctor may order one or more imaging tests, such as a mammogram.

Doctors recommend that women have regular clinical breast exams and mammograms to find breast cancer early. Treatment is more likely to work well when breast cancer is detected early.

You may want to read the NCI booklet Understanding Breast Changes ¹. It describes types of breast changes and tests used to find changes.

Clinical Breast Exam

During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips. Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.

Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side and then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.

If you have a lump, your health care provider will feel its size, shape, and texture. Your health care provider will also check to see if the lump moves easily. Benign lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer, but further tests are needed to diagnose the problem.

Mammogram

A mammogram is an x-ray picture of tissues inside the breast. Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.

Before they have symptoms, women should get regular screening mammograms to detect breast cancer early:

• Women in their 40s and older should have mammograms every 1 or 2 years.
• Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them.

If the mammogram shows an abnormal area of the breast, your doctor may order clearer, more detailed images of that area. Doctors use diagnostic mammograms to learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast. They may involve special techniques and more views than screening mammograms.

To learn more about mammograms, you may want to read the NCI fact sheet Mammograms ².

Other Imaging Tests

If an abnormal area is found during a clinical breast exam or with a mammogram, the doctor may order other imaging tests:

• Ultrasound: A woman with a lump or other breast change may have an ultrasound test. An ultrasound device sends out sound waves that people can't hear. The sound waves bounce off breast tissues. A computer uses the echoes to create a picture. The picture may show whether a lump is solid, filled with fluid (a cyst), or a mixture of both. Cysts usually are not cancer. But a solid lump may be cancer.
• MRI: MRI uses a powerful magnet linked to a computer. It makes detailed pictures of breast tissue. These pictures can show the difference between normal and diseased tissue.

Biopsy

A biopsy is the removal of tissue to look for cancer cells. A biopsy is the only way to tell for sure if cancer is present.

You may need to have a biopsy if an abnormal area is found. An abnormal area may be felt during a clinical breast exam but not seen on a mammogram. Or an abnormal area could be seen on a mammogram but not be felt during a clinical breast exam. In this case, doctors can use imaging procedures (such as a mammogram, an ultrasound, or MRI) to help see the area and remove tissue.

Your doctor may refer you to a surgeon or breast disease specialist for a biopsy. The surgeon or doctor will remove fluid or tissue from your breast in one of several ways:

• Fine-needle aspiration biopsy: Your doctor uses a thin needle to remove cells or fluid from a breast lump.
• Core biopsy: Your doctor uses a wide needle to remove a sample of breast tissue.
• Skin biopsy: If there are skin changes on your breast, your doctor may take a small sample of skin.
• Surgical biopsy: Your surgeon removes a sample of tissue.
  • An incisional biopsy takes a part of the lump or abnormal area.
  • An excisional biopsy takes the entire lump or abnormal area.

A pathologist will check the tissue or fluid removed from your breast for cancer cells. If cancer cells are found, the pathologist can tell what kind of cancer it is. The most common type of breast cancer is ductal carcinoma. It begins in the cells that line the breast ducts. Lobular carcinoma is another type. It begins in the lobules of the breast.

Lab Tests with Breast Tissue

If you are diagnosed with breast cancer, your doctor may order special lab tests on the breast tissue that was removed:

• Hormone receptor tests: Some breast tumors need hormones to grow. These tumors have receptors for the hormones estrogen, progesterone, or both. If the hormone receptor tests show that the breast tumor has these receptors, then hormone therapy is most often recommended as a treatment option. See the Hormone Therapy ³ section.
• HER2/neu test: HER2/neu protein is found on some types of cancer cells. This test shows whether the tissue either has too much HER2/neu protein or too many copies of its gene. If the breast tumor has too much HER2/neu, then targeted therapy may be a treatment option. See the Targeted Therapy ⁴ section.

It may take several weeks to get the results of these tests. The test results help your doctor decide which cancer treatments may be options for you.

Dictionary Terms

A loss of feeling or awareness caused by drugs or other substances. Anesthesia keeps patients from feeling pain during surgery or other procedures. Local anesthesia is a loss of feeling in one small area of the body. Regional anesthesia is a loss of feeling in a part of the body, such as an arm or leg. General anesthesia is a loss of feeling and a complete loss of awareness that feels like a very deep sleep.

A mineral needed for healthy teeth, bones, and other body tissues. It is the most common mineral in the body. A deposit of calcium in body tissues, such as breast tissue, may be a sign of disease.

Cancer that begins in the skin or in tissues that line or cover internal organs.

A physical exam of the breast performed by a health care provider to check for lumps or other changes. Also called CBE.

The removal of a tissue sample with a wide needle for examination under a microscope. Also called core needle biopsy.

A sac or capsule in the body. It may be filled with fluid or other material.

X-ray of the breasts used to check for breast cancer after a lump or other sign or symptom of breast cancer has been found.

A type of hormone made by the body that helps develop and maintain female sex characteristics and the growth of long bones. Estrogens can also be made in the laboratory. They may be used as a type of birth control and to treat symptoms of menopause, menstrual disorders, osteoporosis, and other conditions.

A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.

The removal of tissue or fluid with a thin needle for examination under a microscope. Also called FNA biopsy.

A protein involved in normal cell growth. It is found on some types of cancer cells, including breast and ovarian. Cancer cells removed from the body may be tested for the presence of HER2/neu to help decide the best type of treatment. HER2/neu is a type of receptor tyrosine kinase. Also called c-erbB-2, human EGF receptor 2, and human epidermal growth factor receptor 2.

A cell protein that binds a specific hormone. The hormone receptor may be on the surface of the cell or inside the cell. Many changes take place in a cell after a hormone binds to its receptor.

Treatment that adds, blocks, or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body’s natural hormones. Sometimes surgery is needed to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy, and hormone treatment.

A surgical procedure in which a portion of a lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope to check for signs of disease.

A tiny deposit of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present.

A procedure in which radio waves and a powerful magnet linked to a computer is used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.

A doctor who identifies diseases by studying cells and tissues under a microscope.

A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant.

A type of hormone made by the body that plays a role in the menstrual cycle and pregnancy. Progesterone can also be made in the laboratory. It may be used as a type of birth control and to treat menstrual disorders, infertility, symptoms of menopause, and other conditions.

X-rays of the breasts taken to check for breast cancer in the absence of signs or symptoms.

A doctor who removes or repairs a part of the body by operating on the patient.

The removal of tissue by a surgeon for examination by a pathologist. The pathologist may study the tissue under a microscope.

A type of treatment that uses drugs or other substances, such as monoclonal antibodies, to identify and attack specific cancer cells. Targeted therapy may have fewer side effects than other types of cancer treatments.

A procedure in which high-energy sound waves are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram. Also called ultrasonography.