Many factors are important for the diagnosis of breast cancer, such as
- the size of the breast,
- the density of the glandular tissue and
- the age of the patient.
It is therefore not possible to give a general answer as to exactly when breast cancer can be diagnosed. Inexperienced people can usually feel a lump from two centimetres in size, depending on the size of the breast. An experienced gynaecologist can also feel lumps between one and 1.5 centimetres in size.
Earlier detection is possible with the help of imaging techniques. Calcifications in the breast can be detected using mammography. Calcifications are often found in so-called in-situ carcinomas. This allows lumps to be detected before they develop.
Under optimal conditions, doctors can use ultrasound and magnetic resonance imaging(MRI) to detect tumors as small as five to ten millimeters.
Below you will find an overview of the procedures used in breast cancer diagnostics.
The gynecologist is your first point of contact when breast cancer is suspected. The diagnosis always begins with a medical history. In a detailed consultation, your gynecologist will ask you about possible
- complaints,
- previous illnesses and
- medical history in the family environment
family history.
During the subsequent physical examination , he will palpate your breasts. He will check for possible lumps and their location and size. The doctor will also palpate the armpits to detect enlarged lymph nodes.
The size of the breast is the most important factor in detecting breast cancer by palpation. The location of the lump also plays an important role. The deeper the lump is located, the later it will be detected and the larger it will be at the time of diagnosis. Superficial lumps can usually be felt earlier.
You can also carry out palpation tests yourself. This is done by the gynecologist during the annual check-up.
In many women, the glandular tissue tends to be nodular by nature. Unfortunately, this makes tumorous changes more difficult to feel. The palpation examination also only provides an indication of tissue changes. It does not provide any information about benignity or malignancy.
Imaging procedures are essential for the early detection and detailed diagnosis of breast cancer. Typical procedures are
- Mammography (X-ray examination)
- Mammasonography (ultrasound examination)
- Magnetic resonance imaging (MRI)
Mammography and breast sonography are the classic standard procedures in breast cancer diagnostics. Magnetic resonance imaging is used when the standard examinations have not answered all the diagnostic questions.
Mammography
Mammography is an X-ray examination. The procedure provides images of the breast in different planes. The standard settings of a mammogram are
- the view from top to bottom,
- from the center to the outside and
- from the center front to the outside back.
If necessary, special images (e.g. of the armpit, décolleté) are also taken to better visualize certain areas.
Performing a mammogram © RFBSIP | AdobeStock
Breast sonography
The X-ray examination is supplemented by ultrasound examinations of the breast. However, breast sonography cannot replace a mammogram.
It is particularly useful where mammography reaches its limits: in the case of very dense breast tissue. Even if a mammogram is already very informative, breast sonography can provide an even better diagnosis.
The results of ultrasound examinations are highly dependent on
- the quality of the device and
- the experience of the examining doctor.
the examining doctor. For this reason, mammography and breast sonography should be performed by an experienced specialist.
Magnetic resonance imaging
If the results of the mammography and breast sonography are not conclusive, a magnetic resonance imaging (MRI) scan is also carried out. The results are very accurate. They help to assess whether the carcinoma is also present in other parts of the breast or has already spread.
After the imaging procedures have been carried out, it must be clarified whether the change is benign or malignant. This is where a histological examination comes into play.
A so-called punch biopsy is carried out for this purpose. This is an outpatient procedure.
The surgical approach to tumors is easier to plan, as the doctor can get an idea of the situation thanks to the results of the punch biopsy. As a result, the safety margins around the tumor can be precisely maintained and the results are also better from a cosmetic point of view.
Frequently asked questions about biopsies:
Is it possible for cancer cells to spread in the body as a result of the biopsy?
Although the spread of cancer cells can never be completely ruled out, the risk is very low. Studies have shown that cancer cells are more likely to die in a different location than to grow.
Is the biopsy painful?
The moment when the needle is inserted into the skin is somewhat unpleasant. For this reason, a local anesthetic is used and pain is hardly felt.
Is there any change in the appearance of the breast after the examination?
Biopsies with fine needles usually leave no visible scars. However, as thicker needles are used for punch biopsies, minor scarring cannot be completely ruled out.
There are other procedures available for breast cancer diagnostics.
Galactography
In the case of unclear mammography and breast sonography findings, galactography can be helpful. In this procedure, the milk ducts are visualized in the X-ray image with the help of a previously injected contrast agent.
This makes it easier to identify possible changes in the milk ducts.
Thermography
Thermography of the breast can also play a role as an examination procedure in breast cancer diagnostics. The doctor uses infrared analysis to measure the heat radiation of the tissue.
Tumorous tissue is supplied with more blood and therefore generates more heat. This heat radiation should be clearly visible in a thermography.
However, benign tissue changes can also develop heat. Therefore, thermography cannot provide clear results regarding the benign or malignant nature of a lump. It is therefore not covered by health insurance.
Laboratory tests
For the laboratory test, blood is taken from you and examined for certain characteristics. These properties show how the liver, kidneys and other organ systems function.
In the case of breast cancer, it is essential to confirm the diagnosis for further treatment. This involves a comparison between the diagnostician and pathologist. They check the results of the imaging procedures and histological examinations.
In practice, this means the following: If a malignant finding is suspected in the mammogram and the findings of the punch biopsy are unremarkable, a quality control of the biopsy must be carried out.
The pathologist and the doctor performing the punch biopsy check the plausibility of the examination results together. If the results are congruent, a reliable diagnosis can be assumed. Appropriate treatment measures can then be initiated.
Breast cancer diagnostics involves an enormous organizational and logistical effort. For this reason, diagnoses are usually carried out at certified breast centers. Treatment is also carried out at specialized breast cancer centers.
A great deal of experience is important for the reliable assessment of diagnostic results © okrasiuk | AdobeStock
Breast cancer develops over a period of around five to ten years. Only then does the lump reach a palpable size. However, there are also types of cancer that grow more quickly or more slowly.
Cancers that are very similar to breast cells grow much more slowly than cancers that have little resemblance to breast cells. However, even fast-growing breast cancers can take several years to become detectable.
This is why breast cancer diagnostics pursue the following goals:
- early detection of previously undetected breast cancer cells
- outpatient diagnostic confirmation
- Carrying out all diagnostic steps, ideally in one appointment
- Improving the quality of treatment and patient satisfaction as well as simultaneously improving quality of life
- Reducing the risk of mortality and improving the recovery rate
In addition, a thorough and high-quality breast cancer diagnosis helps to ensure that women are better informed about breast health issues and breast diseases.
Further information can also be found on the advice pages of the Breast Center of the University Women's Hospital Tübingen.
