If a woman has any breast symptoms it is very important that she consult her doctor so that the cause of these symptoms can be found. If breast cancer is found at an early stage this improves the chances of recovery. As a rule, the doctor will ask her a number of questions.
Does the lump vary in relation to her menstrual cycle?
What previous breast problems has she had?
Is there any breast cancer in her family?
How many children has she had?
Physical examinationThe doctor will look at her breasts, first with her arms by her sides, then above her head and, finally, with her arms pressing on her hips. By looking carefully at the outline of the breast in various positions, the doctor can often see changes in the outline of the breast, which will help identify the site and cause of any problems. Next, her breasts are examined while she is lying flat with her arms folded under her head.If, during this examination, the doctor finds a lump, he or she will concentrate on this area examining with the fingertips and measuring the lump. After checking her breasts, the doctor usually carefully examines the lymph glands under the patient's arm pit and those in the lower part of her neck. Should the patient need any further investigations, the breast specialist in the breast clinic will organise any tests that are necessary.
MammogramsIf the patient is over 35 and has not had a breast X-ray within the past year, the doctor may arrange for one to be performed. Breast X-rays are known as mammograms. Mammograms are a good way of identifying abnormalities in the breast, but they don't always tell whether they are benign or malignant. Further tests are sometimes necessary and these tests include ultrasound and fine needle aspiration cytology (FNAC).
Ultrasound scanningX-rays do not pass easily through the breasts of young women. Ultrasound scanning, which is familiar to many women by its use to look at babies during pregnancy, can also be used in the breast to tell whether a lump is fluid or solid. Ultrasound is not useful as a screening test. It is useful if an abnormal shadow is seen on the mammogram because ultrasound is an accurate way of judging whether any abnormality is benign and straightforward or whether it is more likely to be serious.
Needle tests (FNAC)Inserting a needle into the lump will show whether it is full of fluid (a cyst) or solid. The needle can allow a sample of cells to be removed for examination under the microscope (a process called cytology) and this is a very accurate method of finding out whether the lump is benign or malignant.If there is an abnormality on the mammogram, but no lump to feel, then using either the X-ray machine or the ultrasound machine, it is possible to guide the needle into the area of abnormality and to obtain enough cells or tissue to obtain a definite diagnosis. The very fine needles used for this procedure give rise to its name.Having the lump removed After investigation, the doctor may decide the lump is benign and that it can be left alone. Alternatively the doctor may suggest that the lump should be removed. This is called an excision biopsy and it can be performed either while the patient is awake under local anaesthesia or, more commonly, under a general anaesthetic. Before any operation, the patient will be asked to sign a consent form agreeing to the removal of the lump. It is important for the patient to know that the doctor performing the operation will only remove the lump and will not take any more tissue away without explaining any further procedure to the patient first and being given her consent