We hope that our readers are teaching their friends and family to examine their breasts every month, and encouraging those over the age of forty to go for annual mammograms. But what if they find a lump, and go for a mammogram or an ultrasound, and the results seem to confirm that there is “something” there?
Don’t panic! Most lumps are just lumps! Only one out of every ten will be cancer. Even so, EVERY lump must be treated with suspicion and the correct diagnostic tests carried out. If someone phones you in a panic, remain calm for them, tell them about the one in ten statistic and then INSIST that they go for an image-guided biopsy. Offer to go with them if they are nervous. On the other hand, if someone you know finds a lump and the doctor, without sending them for imaging and a biopsy, decides that it is nothing to worry about – do not stop nagging until they have agreed to go to a different doctor and go for further tests!!
Most breast clinics employ a triple assessment method for any, and all, breast abnormalities. In clinics that have adopted this assessment method the diagnostic accuracy is almost 100%. The method includes:
1st – A clinical breast examination
2nd – Diagnostic imaging (such as a mammogram and sonar or ultrasound)
3rd – An image-guided percutaneous (through the skin) biopsy. A small amount of tissue is removed from the lump and sent away for analysis (histopathology). Biopsies are always done last as they can cause minor swelling that may lead to lumps being misdiagnosed.
When doctors rely on clinical breast examinations alone, small and early cancers can be missed, especially in younger women. In 25% of women under the age of 45 (compared to an overall average of 5%) treatment is delayed because the doctors decide, based only on a clinical exam or diagnostic image, that there is nothing to worry about. For women under 30 the misdiagnosis figure is even higher.
For women under the age of 35 imaging is via an ultrasound whereas women over 35 should go for a mammogram and sonar. Sonar imaging in combination with a mammogram drastically increases diagnostic accuracy and the new, digital, mammograms provide greatly improved accuracy in women under 50 and those with dense breasts.
International guidelines recommend percutaneous needle biopsies and, when this is done using image-guidance, the biopsy is most likely to contain the tissue required for determining the characteristics of the tumour. Unguided biopsies, particularly Fine Needle Aspirations (FNA), can provide inconclusive results and results will not show whether the cancer is invasive or in-situ, the hormone-receptor status, grade or type.
The goal of a biopsy is to diagnose, not to treat. When FNA results are poor many doctors will recommend a surgical biopsy, saying that it will also treat the condition. This can be expensive, will require time off work, can be unsightly (depending on the amount of tissue removed) and may impact on later treatments if a tumour is present. In many cases surgical biopsies may also limit later breast-conserving options.
Breast specialists agree that surgical biopsies should be reserved for the hardest patients to diagnose: where the lump is very close to implants or the chest wall or when the lump cannot be seen on any imaging. Call Bosom Buddies on 0860-283-343 for the details of breast specialists in your area.
For most women an image-guided core biopsy (obtaining 3-5 samples) will be sufficient. Your loved one will be left with a pin-prick of a scar, suffer minimal pain, avoid a costly hospital stay, and obtain a definitive answer.
Written by Dr Carol-Ann Benn and Dr Sarah Rayne