Investigations

It is important to be aware of how your breasts usually look and feel so you can quickly pick up on any changes that may occur.

See your GP if you notice a lump in your breast or any change in its appearance, feel or shape. Your GP may ask you a number of questions, including:

  • when you first noticed the lump
  • whether you have any other symptoms, such as pain or a discharge from your nipple
  • whether your symptoms change with your menstrual cycle
  • whether you have ever injured your breast
  • whether you have any risk factors for breast cancer, such as a close family member who has previously had breast cancer
  • what medications you are currently taking
  • whether you are currently breastfeeding or whether you have done so in the past

Your GP will carry out a physical examination of both of your breasts, including the lump, and may refer you to a breast clinic. In the breast clinic you will be seen by a clinician who may carry out a triple assessment (clinical examination, radiological and needle biopsy test)

Mammogram

A mammogram is a breast x-ray. You may have a mammogram as part of a national breast screening programme, or if you’ve been referred to a breast clinic by your GP or been called back to a breast assessment clinic following routine screening.

During your appointment, a female mammography practitioner (an expert in taking breast x-rays) will ask you to undress to the waist and stand in front of the mammogram machine. If you’re pregnant or think you may be pregnant, tell the mammography practitioner.

Your breasts will be placed one at a time on the x-ray machine. The breast will be pressed down firmly on the surface by a clear plate. At least two pictures of each breast will be taken, one from top to bottom and then a second from side to side to also include the part of your breast that extends into your armpit. You will need to stay in this position while the x-ray is taken. You may find it uncomfortable but it only takes a few seconds and the compression doesn’t harm the breasts.

Mammograms are not often used in women under 40. Younger women’s breast tissue can be dense which can make the x-ray image less clear so changes can be harder to identify. However, for some women under 40, mammograms may still be needed to complete the assessment.

Mammograms deliver a very low dose of radiation and is not harmful. The dose is monitored and adjusted according to the person’s individual situation. This ensures that the dose remains as low as possible while still providing a good-quality image.

Ultrasound

If you are under 35 years of age, a breast ultrasound may be recommended because your breast tissue may be too dense for a mammogram. Your doctor may also suggest that you have a breast ultrasound if they need to know whether a lump in your breast is solid or contains liquid.

Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts. An ultrasound probe or sensor will be placed over your breasts to create an image on a television screen. The image will highlight any lumps or abnormalities that may be present in your breasts. Ultrasound is sometimes used to guide needle biopsies and aspiration of cysts/ abscess.

Biopsy

You may need to have a breast biopsy if the cause of your breast lump cannot be diagnosed using a mammogram or ultrasound. A biopsy is a procedure that involves removing a tissue sample from the lump for further testing. Please let the team know if you have any bleeding disorder, or if you take any blood thinning tablet/ injection.

During a biopsy, a fine needle will be inserted into the lump in your breast so that a sample of tissue can be removed. The sample will then be examined under a microscope to confirm the diagnosis.

Your doctor or nurse will give you information about the procedure and ask you to sign a consent form. This is a good time to ask any questions that you have.

The test takes about 20 minutes. You lie on a couch and the doctor or nurse does an ultrasound of your breast. This finds the right place to take the sample.

The doctor or nurse cleans the breast area. They might use a local anaesthetic to numb the skin, which might sting a little. Then they gently put a hollow needle into your breast and take a sample of cells. You will feel some pressure on the breast but it shouldn’t be too painful. Let the doctor know if it’s painful for you. When they have the sample of cells they remove the needle. They might take more than one sample to make sure there is enough tissue to look at under the microscope. After your needle biopsy you can get dressed and go home or back to work straight afterwards if you like. But try not to do too much for the rest of the day.

You can take paracetamol if your breast is sore or tender. Your doctor or nurse will let you know how to look after the biopsy area and your dressing. You can have a shower or bath as normal if you have a waterproof dressing.

You might see some bruising/ swelling in the area and this is normal. It will go after a week or two. Once the team have got your triple assessment result they then discuss the case at a Multidisciplinary Team (MDT) and then review you in clinic to give a treatment plan.

Waiting for test results can be a very worrying time. You might have contact details for a specialist nurse who you can contact for information if you need to. It can help to talk to a close friend or relative about how you feel.

Breast MRI

In addition to triple assessment, breast MRI (Magnetic Resonance Imaging) has a useful role in selected cases (young patients and implants) as a problem-solving tool to help diagnose breast cancer or to give further information.

MRI does not involve x-ray irradiation but uses a very strong magnetic field. It requires specially trained radiographers to perform the test and takes 45-60 minutes. All breast MRI examinations are carried out at the Royal Devon & Exeter Hospital and double read by experienced breast dedicated radiologists.

It is most often used to give further information following a mammogram and ultrasound. In many cases, an additional breast ultrasound is performed after the MRI to clarify its findings. It is sometimes used to assess the response of a cancer to chemotherapy or hormone treatment prior to surgery.

In addition to its role as a diagnostic tool, breast MRI is useful in screening younger women at a significantly increased risk of breast cancer either as a result of a very strong family history or a mutated breast cancer gene (BRCA1 or BRCA2), or following chest mantle irradiation for Hodgkin’s disease at a young age. MRI is often helpful for these women because it is effective in dense breast tissue and many youn­­­g women have dense breasts.

However, mammography and ultrasound remain the most useful diagnostic breast imaging methods and even where MRI is recommended for women at high risk of the disease, it is used in conjunction with mammography and ultrasound for selected women. Breast MRI is a very specialised technique and the results take longer to process.

If the test has been performed for a suspicious or known breast cancer, you will be given an appointment to return to the clinic to discuss your results with a specialist. Following the Breast MRI examination, many patients are called back for a further ultrasound of the breast as this helps the radiologist to interpret the MRI findings. This is known as a “second look ultrasound”

Last updated: July 17, 2019