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Diagnosis

 
Diagnosis

Chapter: 4 - Diagnosis

Subchapter: 3 - Diagnostic Methods

Breast Health Awareness
Becoming familiar with your breasts and knowing what is normal for you will help you detect changes or abnormalities, if they occur. This is breast health awareness.

The initial sign of breast cancer may involve a new lump or change in the breast. A new nipple inversion, an area of significant irritation or redness, dimpling or thickening of the breast skin, and persistent breast pain or discomfort are reasons to seek prompt medical evaluation.

Breast Self-Exam
A breast self-exam is an examination of the breasts for changes or abnormalities. A self breast-exam should be performed monthly and any changes or abnormalities should be discussed with your doctor or physician. For more information about how to perform a breast self-exam, please visit http://nbcf.org.

Clinical Breast Exam
A clinical breast exam is an exam preformed by a qualified nurse or doctor; they will check for lumps or other physical changes in the breast. The goal is to detect breast cancer in its earliest stages, either by evaluating the patient’s symptoms or finding breast abnormalities.

Mammogram
Having a regularly scheduled mammogram, the standard diagnostic scan, is especially important. A mammogram is an x-ray; the breast is exposed to a small dose of iodizing radiation that produces an image of the breast tissue.

If your mammogram or a clinical exam detects a suspicious site, further investigation is always necessary. Although lumps are usually non-cancerous, the only way to be certain is to obtain additional tests, such as an ultrasound. If a solid mass appears on the ultrasound, your radiologist may recommend a biopsy, a procedure in which cells are removed from a suspicious area to check for the presence of cancer.

Early Detection Plan®
Because early detection is so vital, the National Breast Cancer Foundation offers women the Early Detection Plan®, an online tool that helps remind you to schedule a breast self-exam, clinical breast exam, and mammogram. Because of the demands of everyday life, it’s easy to forget or even fear these exams; which is why this program exists. You can subscribe to receive alerts by e-mail, text message, and even through an RSS feed. It only takes 60 seconds to create an Early Detection Plan, but it could save your life.

Ultrasound and MRI
As we mentioned previously, when a suspicious site is detected in your breast, your doctor may require an ultrasound of the breast tissue. An ultrasound is a scan that uses sound waves to paint a picture of what’s going on inside of the body. Ultrasounds are helpful when a lump is easily felt and can be used to further evaluate any abnormalities discovered on a mammogram.

Each exam will provide a different perspective. When your initial exams are not conclusive, your doctor may recommend an MRI to asses the extent of the disease. An MRI (magnetic resonance imaging) is a scan of the body that uses magnetic energy and radio waves, rather than radiation, to view organs and tissues in the body.

Related Questions

  • Nicole Adams Profile

    Does a mammogram hurt?

    Asked by anonymous

    Learning About Breast Cancer
    almost 9 years 8 answers
    • View all 8 answers
    • Thumb avatar default
      anonymous
      Learning About Breast Cancer

      I am always concerned when a question is asked about pain levels associated with ANY procedure related to breast cancer and the responses are uniformally rosy or at least, minimal when it comes to reporting pain.
      The real answer is - the pain levels depend on a host of factors and it can vary...

      more

      I am always concerned when a question is asked about pain levels associated with ANY procedure related to breast cancer and the responses are uniformally rosy or at least, minimal when it comes to reporting pain.
      The real answer is - the pain levels depend on a host of factors and it can vary enormously from one women to another. For example, if you have dense breasts and a history of breast pain and sensitivity to having your breasts touched heavily or manipulated, as well as strong hormone related breast pain, then it is feasible that you will find mammograms painful. Further, scientists have recently found that sensitivity to pain is genetically based, so if you are part of the population who have the pain sensitivity genetic make up [you will know who you are as you will have a history of people assuring you X or Y does not hurt much but when you have it, the roof of yor head blasts off with pain - thats when they start calling you a wimp or pathetic or whatever] then your experience more pain than those without the gene.

      I am so sick of the ability to withstand pain being portrayed as a moral virtue when in fact a lot of it is the luck of the draw with genetics.

      I also regularly run into women who actively avoid much needed mammograms because of the pain. I then see scientific studies where resources are poured into answering the question "wh do women avoid having mammograms even when they are free?" One reason they regulary fail to cite is the pain. Yes, pain NOT discomfort.

      I am writing this because I am a breast cancer survivor who not only finds mammograms very painful, I am also one of the 40% of women who developed breast seroma following surgery. A seroma is a fluid filled sac in the breast which in my case although smallish, is also very painful. I have to hold what remains of my right breast if the car goes over a speed hump as breast jiggling is painful.

      I am supposed to have my first post surgery annual mammogram in about 8 weeks.The idea of my scarred breast with a seroma, which already experienced bad pain on mammograms without these features scares the dickens out of me. I had an MRI [which I paid for myself] late last year - zero radiation, zero pain and a far more sensitive test for invasive ie., the most dangerous kind of breast cancer. In my case, due to dense breasts, mammograms are also only around 60% accurate albeit better at detecting non-invasive forms of breast cancer.
      I have now decided I am not going to put up with the pain from mammograms any more. I have therefore written to the centre that will be conducting my annual mammograms for the rest of my life and said I do not consent to having any mammograms done in future without adequate pain relief. I know from experience a local anesthetic injection - which I tolerate well - completely ends all pain. I am also willing to consider trialling a numbing agent like EMLA cream applied an ahour or two before the mammogram and wrapped in saran and/or breathing through one of those pain relief tubes ambulances and paramedics carry with them.
      If anyone reading this has any concerns about the pain involved in having your breasts - with or without surgeyr scars and seromas - squeeed and flattened to one inch thick - then I urge you to contact the mammogaphic service ahead of your appiontment and put it in writing that your consent to the procedure in contingent on being provided with a decent choice of pain relief.
      Do not be held to the standard of the most stoic or tough patient and refuse to be emotionally blackmailed into shutting up and suffering needlessly. The pain relief options I have llisted are cheap, simple and used every minute of every day in all sorts of medical settings, so the side effects are minimal.
      Don't let them get away with hurting you if avoiding being subject to pain is a priority to you. By all means if avoiding or embracing physical pain is acceptable to you - then go ahead without pain relief.

      Comment
    • Thumb avatar default
      anonymous
      Learning About Breast Cancer

      I find them very painful. I had one years ago because a lump was found. I'm small and the area is dense, so all I kept hearing was how little fat I had from the technician to the specialist. I then had to go for an ultrasound anyway because they couldn't really see because of the density. I...

      more

      I find them very painful. I had one years ago because a lump was found. I'm small and the area is dense, so all I kept hearing was how little fat I had from the technician to the specialist. I then had to go for an ultrasound anyway because they couldn't really see because of the density. I ended up with scrapes above and below my breasts and pain for quite a while after.
      I haven't gone again because of the pain, but know that I'm supposed to. If the same thing happens, what's the point? Still the doctor insists on the mammogram. This is not how they would look for testicular cancer and some of us find our breasts just as bad for pain. I think it is barbaric how they have not made this test less painful

      Comment
  • julie s Profile

    I finished my 3rd of six chemo rounds today!!half way there! Woo hoo! In two weeks I'll have a status check MRI. I can feel the tumor shrinking so should be good news!!!

    Asked by anonymous

    Stage 2A Patient
    over 7 years 6 answers
    • View all 6 answers
    • Marianne R. Profile
      anonymous
      Survivor since 2011

      Yeah!!!!! For you!!!! God bless

      Comment
    • Erin Timlin Profile
      anonymous
      Survivor since 2011

      I could feel my tumor shrinking too and I had a total response!! There was nothing left in the breast or nodes after completing 8 rounds of chemo. Good luck!! Keep envisioning that tumor GONE!!!!!

      Comment
  • nancy  wilcox Profile

    well I got a partial result from the bilateral breast MRI from the nurse --said "probably benign with no signs of metastasis "--will get the full report from doctor on Monday. I do not like that "probably" word. Please tell me what you think?

    Asked by anonymous

    Learning About Breast Cancer
    almost 8 years 2 answers
    • Lysa Allison Profile
      anonymous
      Learning About Breast Cancer

      My doctor told me they will never give you a definitive answer because they really don't know absolutely and they open themselves up to lawsuits if they say you do not have cancer then something shows up. I am living my life as though it will never happen again. Best of luck to you and God bless...

      more

      My doctor told me they will never give you a definitive answer because they really don't know absolutely and they open themselves up to lawsuits if they say you do not have cancer then something shows up. I am living my life as though it will never happen again. Best of luck to you and God bless you!

      1 comment
    • Ali S Profile
      anonymous
      Survivor since 2011

      I hate that word too bc my PCP said "it's probably a cyst, you're too young" and sure enough , it was cancer. The waiting is the worst and we are all here for you with whatever news you receive.

      Comment
  • karen johnston Profile

    What are complex scholoric lesions?

    Asked by anonymous

    Learning About Breast Cancer
    about 8 years 2 answers
    • Coco Smith Profile
      anonymous
      Learning About Breast Cancer

      It is called complex because it is so difficult to accurately diagnose and can overlap with other conditions.

      Putting it as simply as possible - your skin cells have been increasing at a rate considered too fast and this has now formed a mass or a lesion.
      You are posting on a breast cancer...

      more

      It is called complex because it is so difficult to accurately diagnose and can overlap with other conditions.

      Putting it as simply as possible - your skin cells have been increasing at a rate considered too fast and this has now formed a mass or a lesion.
      You are posting on a breast cancer website so the mass or lesion is likely to be in your breast. They can be located throughout the body however.

      The main Sclerosing lesions are:
      - sclerosing adenosis (SA),
      - microglandular adenosis (MGA) and
      - radial scar/complex sclerosing lesion (RS/CSL). Scars from breast cancer or other surgery or injuries for example.

      All can cause diagnostic problems clinically, imaging problems (ultrasound and mammography) and histopathological problems.

      Sclerosing adenosis and complex sclerosing lesion may have masses you can feel - so they can be mistaken for invasive breast cancer. They can also have tiny microcalcifications -so this can mimic the appearances of DCIS on a mammography.

      SA and RS/CSL seen on a mammography or ultrasound may appear as an architectural distortion or spiculated mass. It is complex because we cannot confidently say it is or is not that or cancer so a tissue sample it taken. Usually via a needle core biopsy. The complexity remains even on tissue diagnostic as interpreting samples is also difficult.

      Great care is taken because these lesions can be cancer and the risk of a mistaken diagnosis exists.

      If there is any doubt about the correct diagnosis immunostaining with anti-smooth muscle actin assists diagnosis.

      Some surgeons have a policy to excise [cut out] all parenchymal distortions or architectural deformities just in case they are cancer and the complexity of the diagnostic problems like the ones I have mentioned here means they prefer an abundance of caution. Others so not have this surgical policy.

      You need to ensure you continue to work through the process carefully because getting a accurate diagnosis with this is such a challenge.
      Good luck!

      Comment
    • Thumb avatar default
      anonymous
      Learning About Breast Cancer

      I think you mean complex sclerotic lesions. A sclerotic lesion is scar-like tissue that can look or feel like a mass. The doctor needs to evaluate it further to make sure cancer cells aren't hiding in it.

      Comment

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