See your doctor if you notice a lump in your breast, or any change in the appearance, feel, or shape of your breasts. Your doctor will examine your breasts, and if they think that you may have breast cancer, they will be able to refer you to a specialist breast clinic for tests.

At the breast clinic, a specialist, or specialist breast nurse, will carry out tests to determine whether or not you have breast cancer. If you have breast cancer, the tests will also show what type of breast cancer you have. Your specialist, or nurse, will be able to determine the best way to treat you. They may also take photographs of your breasts in order to keep a record of their current appearance, and any further changes which may occur.

If you are diagnosed with breast cancer, the tests can also help to identify the stage and grade of your condition, which your oncologist (specialist in cancer) will discuss with you thoroughly. The stage is used to describe the spread of the cancer at the time of diagnosis, and the grade indicates how aggressively it is spreading.

Determining the stage and grade of your breast cancer will help your doctors to decide on the best kind of treatment for your condition. However, it is important to remember that the stage and grade of your breast cancer alone cannot predict how your condition will progress. The way in which your condition will progress also depends on factors such as the type of breast cancer that you have and your overall health.

The various tests that you may have to diagnose breast cancer, and those which determine specific types of treatment, are outlined below.

Tests to diagnose breast cancer

Blood test

A sample of your blood will be taken so that your doctor can assess your overall health, as well as how well your liver and kidneys are working.

Mammogram

A mammogram is a simple procedure which uses X-rays to create an image of the inside of your breasts. This can help to identify early changes in your breast tissue when it may be difficult to feel a lump. However, as younger women tend to have denser breasts in which changes are more difficult to identify, a mammogram is not as effective if you are under the age of 35. If this is the case, your doctor may suggest that you have a breast ultrasound instead.

If you need to have a mammogram, your radiographer (X-ray specialist) will position one of your breasts on a flat X-ray plate. A second X-ray plate will press down on your breast from above, so that it is temporarily compressed and flattened between the two plates. An X-ray will then be taken which will give the clearest possible image of the inside of your breast. The procedure will then be carried out on your other breast.

A mammogram only takes a few minutes and you may find it a bit uncomfortable, or even a little painful. Your doctor will examine the mammography for indications of cancer, such as calcification (areas of calcium within your breast tissue) that show up on an X-ray. However, if you have calcification, it does not mean that you have cancer, and you will need further tests to confirm a diagnosis.

Breast ultrasound

You may need to have a breast ultrasound if you are under the age of 35 because your breasts may be too dense for a mammogram. Your doctor may also suggest 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 your breasts, in the same way that an unborn baby can be seen in the womb. An ultrasound probe, or sensor, will be placed over your breasts in order to create an image on a screen. The image produced will show any lumps, or abnormalities, that may be present in your breasts.

Biopsy

A biopsy involves taking a sample of tissue cells from your breast and testing them to see if they are cancerous. Biopsies can be taken in different ways, and the type you will have will depend on what your doctor knows about your condition so far. The different methods of performing a biopsy are outlined below.

• Needle aspiration - this type of biopsy may be used to test a sample of your breast cells for cancer, or to drain a benign cyst (small fluid-filled lump). Your doctor will use a small needle to extract a sample of cells, without removing any tissue.
• Needle biopsy - this is the most common type of biopsy, in which a sample of tissue is taken from a lump in your breast using a large needle. You will have a local anesthetic, which means that you will be awake but your breast will be numb. Your doctor may suggest that you have a needle biopsy if they need to know whether or not the cancer has spread, as it allows them to examine it within your tissue, rather than after it has been extracted from it.
• Surgical or excision biopsy - this type of biopsy is carried out under general anesthetic, which means that you will be asleep during the procedure. Your doctor will surgically remove all, or part, of a lump from your breast in order to test it for cancer.

CT scan or MRI scan

CT and MRI scans produce detailed pictures of the inside of your body and, if necessary, they can be used to highlight the locations in your body where cancer has spread. They can also show in detail the exact size and shape of a lump inside your breast.

A CT scan uses a series of X-rays to form a 3-D image. An MRI scan uses a strong magnetic field and radio waves, and your doctor may suggest it if your mammogram, or breast ultrasound, does not show a lump in your breast in enough detail.

Chest X-ray

You may need to have a chest X-ray if your doctor thinks that your breast cancer may have spread to your lungs.

Bone scan

You may need to have a bone scan if your doctor thinks that the cancer may have spread to your bones. Before a bone scan, a substance containing a small amount of radiation, known as an isotope, will be injected into a vein in your arm, which will be absorbed into your bone if it has been affected by cancer. The affected areas of bone will show up as highlighted areas on the bone scan, which is carried out using a special camera.

The radioactive substance will disappear from your body after a few hours and will not make you radioactive. The amount of radiation used is very small and has no harmful effects. However, as with any form of radiation there is a small risk of it affecting an unborn child, so it is best to avoid contact with pregnant women for the rest of the day, if possible.

Tests to determine specific types of treatment

If you are diagnosed with breast cancer, you will need to have further tests which can show whether or not the cancer will respond to specific types of treatment. Whatever the result of your tests, they can give your doctors a more complete picture of the type of cancer that you have, and how best to treat you.

Hormone receptor test

In some cases, breast cancer cells are stimulated to grow by hormones which occur naturally in your body, such as estrogen and progesterone. If this is the case, the cancer may be treated by stopping the effects of the hormones, or lowering their levels in your body. This is known as hormone therapy.

A sample of cancer cells will be taken from your breast and tested to see if they respond to either estrogen or progesterone. The cancer cells are said to respond if they have areas that let either hormone attach itself to them, which are known as hormone receptors.

If you have cancer cells that respond to estrogen, the type of breast cancer that you have is said to be estrogen receptor positive. If you have cancer cells that respond to progesterone, the type of cancer that you have is said to be progesterone receptor positive. Hormone therapy is most effective on cancers that are estrogen receptor positive, but it is only one of the ways in which breast cancer can be treated.

HER2 test

In the same way that hormones can encourage the growth of some types of breast cancer, other types are stimulated by a protein called HER2. These types of cancer may be treated by blocking the effects of HER2, which is known as biological therapy.

If the test shows that the cancer cells in your breast respond to HER2, it means that they have HER2 receptors, which are areas that let HER2 attach itself to them. The type of cancer that you have is said to be HER2 positive.

Biological therapy can be used on breast cancers that are HER2 positive, but as is the case with hormone therapy, biological therapy is only one of the ways in which breast cancer can be treated.