Breast cancer may become apparent by breast symptoms, changes on breast examination or findings on breast imaging, such as mammogram, ultrasound or MRI. The widespread use of screening mammography has increased the likelihood of breast cancer being detected before it causes any breast symptoms.
Breast pain is the most common breast symptom, but is rarely associated with breast cancer, especially if there are no associated abnormalities on clinical breast exam or mammogram.
Changes on breast examination which may be signs of breast cancer include breast lumps or masses, an area of thickening which feels different from the mirror image area of the opposite breast, nipple discharge, nipple retraction, nipple lesions, skin changes or retraction, enlarged lymph nodes in the underarm or above the collar bone. There is a great deal of overlap in the breast changes caused by breast cancer and benign breast problems. Most of these findings are caused by benign breast problems, but careful evaluation of any breast change is essential. The first step is to have any of these findings evaluated by your doctor; this will include a medical history of the characteristics of the breast symptom, breast cancer risk factors and your general medical history. A clinical breast examination will be performed. The next step may include undergoing a mammogram and/or breast ultrasound. Depending on these findings and your family history of breast cancer, a breast MRI may be indicated on occasion.
Breast cancer may be detected in a woman who is not having any breast symptoms when she has a screening mammogram. A mammogram may identify masses, clustered calcifications or architectural distortion, any of which might be a sign of cancer. 3-D mammography, additional diagnostic mammographic views taken from different angles, magnified or with spot compression, or a targeted breast ultrasound may be helpful in further evaluating an abnormality seen on a screening mammogram. Breast cancer can also be detected on screening breast MRIs performed for women at high risk for breast cancer.
The combination of medical history, clinical breast examination and appropriate breast imaging will often clarify whether a breast abnormality is benign. In cases in which there is a very high likelihood that an abnormality is benign, close monitoring with clinical breast examinations and/or breast imaging may be indicated. However, a breast biopsy is often the only way to know for sure if a breast abnormality is a breast cancer or if it is benign. There are a variety of types of breast biopsies which can be used to make a diagnosis. It is important to consider how the type and way a biopsy is performed might affect future treatment planning. Breast surgeons have unique insight into the ramifications of breast biopsies on future treatment since they not only perform biopsies but also perform definitive breast surgery, whether that is a surgical biopsy or breast cancer surgery.
See Breast Biospies for information about the different types of breast biopsies and their advantages and disadvantages.
See Your Breast Surgeons Role for the ways in which your breast surgeon can facilitate your care.