Tests to diagnose early breast cancer

If you notice a change in your breast or you experience one or more symptoms of early breast cancer, see a doctor or your GP. You may need a range of tests to confirm a diagnosis.

Your doctor will choose the tests based on your symptoms and any tests you have already had. 

The ‘triple test’ approach

Doctors often use the ‘triple test’ to confirm the diagnosis:

1.  physical breast examination and personal history
2. imaging tests
3. biopsy of the abnormal tissue.

Physical breast examination and personal history

They will examine both breasts and the breast area including the lymph nodes under your arms and up to your collarbone.

They will ask you about any family history or personal history of breast cancer.

Imaging tests

You may need 1 or more imaging tests to confirm a diagnosis:

• another mammogram – a low-dose X-ray of the breast. They may recommend this even if you already had a routine screening mammogram through BreastScreen
• an ultrasound. This uses sound waves to help decide if a breast lump is solid or filled with fluid. An ultrasound may be done alone or together with a mammogram to provide more detail.
• a Magnetic Resonance Imaging (MRI) scan. This scan uses a magnetic field and radio waves to create detailed pictures of soft tissue that may not show up in an X-ray.

If these tests detect cancer in your breast, your doctor may request one of the following: CT scan, PET scan or bone scan. This is to see if the cancer has spread to other parts of the body.

Biopsy

A biopsy is a medical procedure to remove a sample of tissue. This is taken from the affected area.

The radiologist takes tissue from the area where a breast abnormality is detected. They send this tissue to a pathologist, who examines it under a microscope. The pathologist’s findings are in the pathology report.

There are several different types of biopsy. These are all done with a local anaesthetic.

• Core biopsy. A needle is used to remove a ‘core’ or tissue sample. This procedure uses ultrasound to accurately identify the affected area of the breast.
• Fine needle aspiration (FNA). A fine needle is inserted into the breast, often under ultrasound. This removes some cells from the affected area in the breast, or a lymph node.
• Vacuum-assisted core biopsy (VAB). A needle is inserted through a small cut (‘incision’) in the skin. This needle has suction equipment attached. It can take a larger amount of tissue as the needle can rotate. Ultrasound, MRI or mammogram is commonly used to guide where the needle is placed.

Surgical biopsy

Occasionally, the results from the core biopsy may be unclear. To come to a final diagnosis, you may need an excisional biopsy. This is usually done under anaesthetic and involves taking a larger sample of tissue..

A surgical biopsy is usually done as a day surgery.

Procedures to locate breast abnormalities 

Before surgery to remove the abnormal tissue in your breast, you may have a small procedure to mark the exact area of the breast abnormality. This makes it easier for the surgeon to find the right spot when they are operating.

They can use a number of different markers to show the area of breast cancer.

Hookwire localisation

This is the most common procedure used to mark the area of the tissue that needs to be removed. The hookwire is a very thin wire with a tiny hook at the end. It is inserted into the breast, with its end at the place the abnormal tissue was found. The hook keeps the wire in the right place.

The procedure usually happens in an X-ray department or private radiology clinic. A radiologist inserts the wire using a mammogram or ultrasound as a guide.

Metal marker

During a biopsy, a small metal clip (or marker) may be put in the breast where the tissue samples are taken. This makes it easier to find the area again if another biopsy or surgery is needed. 

Often you will have a marker clip inserted if you are having neoadjuvant systemic therapy. This helps the surgeon know where to operate, even if nothing is visible on imaging.

It is safe to leave the clip in the breast. It does not need to be removed, even if you do not have any more procedures.

Radioactive seed or magnetic seed

Instead of using a hookwire or marker, some hospitals insert a very low dose radioactive seed or a magnetic seed into the breast tissue. The seed is tiny – less than 5mm long, about the length of a sesame seed – and is made of metal. This procedure can be done up to two weeks before your surgery.

During surgery, a special probe finds the seed. This guides the surgeon to the tissue they need to remove, along with the seed.

Carbon tracking

Another procedure uses a small amount of carbon (‘charcoal suspension’) to guide the surgeon. Under ultrasound or mammography, a needle is injected into the site of the lesion. As the needle is removed, it leaves behind a track or trail of carbon. This directs the surgeon to the tissue they need to remove.

Questions for your treating doctor

• Ask your treating doctor about which tests will be the most appropriate for you, and what those tests will involve.

Resources

• Cancer Australia has information about breast cancer and the triple test.
• Cancer Council explains the different tests for breast cancer.
• If you have other questions about the tests, contact BCNA's Helpline.