How a breast cancer diagnosis is made

January 16, 2019

Providence Health Team

Diagnostic imaging is the way radiology can be used to detect cancer.

The most common imaging tool for breast cancer diagnosis is a mammogram, although ultrasound and breast MRI may also be used in certain cases.

Every effort is made to make the process move as quickly as possible to ease patient anxiety.

An early diagnosis of breast cancer can be the key to successful treatment. But how is that diagnosis made? It relies on diagnostic imaging, in which radiology is used to detect and sometimes treat medical issues. Nicole Lee, MD, a radiologist specializing in women’s imaging at Providence Portland Medical Center, walks us through the steps from screening to diagnosis.

Step 1: The screening mammogram

The majority of Dr. Lee’s patients come to her via their regular screening mammography. “That means we are looking for breast cancer when they don’t have symptoms,” she says. Other patients come in because they are presenting symptoms, such as a lump in the breast, changes to the skin or discharge from the nipple. These patients will undergo diagnostic evaluation usually with mammography. Depending on the patient’s risk factors, there may be additional screening tools such as screening breast ultrasound and MRI sometimes.

Breast MRI is generally reserved for women who have a very high risk of breast cancer due to family history or genetic mutation.

Step 2: Getting the screening test results

A woman who comes in for her regular breast cancer mammography screening doesn’t see a doctor during that visit. The mammogram is read by a radiologist, usually by the next morning. If the radiologist sees something that may require additional imaging, the patient will be contacted.

“At Providence we have coordinators who call patients and let them know the radiologist would like them to come back,” Dr. Lee says. “Getting called back is an anxiety-producing, stressful time for many women so we make an effort to get them in quickly if they want to,”

Step 3: Diagnostic imaging

If the patient is called back from her screening mammogram, the woman will come in for diagnostic evaluation. That typically means additional mammograms and sometimes an ultrasound, or in some cases just an ultrasound, Dr. Lee says. If those tests reveal something that raises concern, the patient will be brought in for a biopsy as soon as possible. “In some instances, it can be the same day, or within a few days after the diagnostic imaging,” Dr. Lee says.

Step 4. Biopsy

The way a biopsy is done depends on how the issue was first spotted: if a mammogram turned up a problem, Dr. Lee would use mammography to biopsy it, and the same goes for ultrasound and breast MRI. “Sometimes I can see something on a mammogram and an ultrasound, and in those cases I will typically do an ultrasound biopsy because it tends to be faster and easier on the patient,” she says.

Once the biopsy method is selected, the procedure is done under local anesthesia. “We take tissue from our target and place a little marker at the site of the biopsy,” Dr. Lee says. “There’s usually some sort of imaging done afterwards, such as a mammogram, to show where that marker is for future reference.”

The day of the biopsy can be a very fraught time for patients. “A lot of women come in anxious and scared, and I often try to ask them if they are worried about the procedure or worried about the results,” Dr. Lee says. “If they are just worried about the procedure, I explain what to expect and talk them through it so it takes their mind off things, which can be helpful. For the women who are worried about the result, I tell them let’s just get through this first step.”

Step 5: Diagnosis

It generally takes three to five business days to come back with a tissue diagnosis after the biopsy, although every effort is made to give patients the news as soon as possible

At Providence Portland Medical Center, Dr. Lee and her colleagues generally call their patients themselves to deliver the news; in some cases, that job falls to the primary care physician. Even when a diagnosis comes back positive for breast cancer, Dr. Lee emphasizes that the screening has done its job.

“Treating a cancer when it is small is much easier than treating it when it is big,” she says. That’s why, she adds, it is important that once women decide on the frequency of their mammography schedule — whether it’s annually or every other year, depending on risk factors and consultation with their doctor—they stick with it. “I see a lot of women who have missed a year or even a few years, and that’s when I see a lot of cancers when there has been that gap.”

Providence Wellness Watch: Breast Cancer Screening