At the breast clinic you will usually have a breast examination, followed by one or more of the following tests:
Mammograms are performed as the first test for patients who are 40 years or over. Ultrasound is performed first for patients who are under 40 years old.
A mammogram is an x-ray of the breast taken by a radiographer. Your breasts will be placed one at a time on the x-ray machine. The breast will be held firmly on the surface by a clear plate to keep it still and get a clear picture. At least two pictures of each breast will be taken. You may find it uncomfortable but each picture only takes a few seconds to complete.
Mammograms deliver a very low dose of radiation (you would receive a similar amount from flying between London and Australia and back).
If you’re pregnant or think you may be pregnant, tell the radiographer.
Sometimes we may need to take further mammograms at different angles or with magnification to look at a area in a greater detail.
An ultrasound scan uses special sound waves to provide a picture of the breast. This is the same technique used to scan babies in the mother’s womb during pregnancy. An ultrasound scan is painless. It can generally be done in a few minutes but it can take longer.
You’ll be asked to lie on a couch with your arm above your head. Some gel will be spread over the area of your breast being scanned. A doctor will use a hand-held probe, which will be moved over the breast to look at the underlying breast tissue. The area under your arm (axilla) may also be scanned.
An ultrasound scan may be done in addition to mammograms. Ultrasound doesn’t involve any radiation.
Having a core biopsy or an FNA doesn’t necessarily mean you have breast cancer.
A core biopsy uses a hollow needle to take one or more samples of breast tissue from the area of concern. A local anaesthetic is given to make the area numb. Either a mammogram or ultrasound is used to guide the needle to the correct area to be sampled.
A small cut is made in the skin to allow the needle to get to the area and take the sample. The needle makes a clicking noise as it takes the sample.
The tissue is then sent to the laboratory where it’s examined under a microscope to check the cells.
FNA involves taking one or more samples of breast cells using a fine needle and syringe. A local anaesthetic is given to make the area numb. The needle is then guided to the correct area using the ultrasound scan.
The sample is sent to the laboratory and the cells are checked under the microscope.
If you’re taking aspirin or any anticoagulants (blood-thinning tablets), let the doctor know before having a core biopsy or an FNA.
Before you leave you will be given an appointment to come back to the clinic for results of the biopsy the next week.
A small dressing will be applied, and you’ll be asked to keep this on for a day or so afterwards. Once the local anaesthetic wears off, your breast may ache and may also become bruised. You can take paracetamol, if the area is tender or painful.
You will be given written information on what to expect following a biopsy.
If the area of concern is small or difficult to see on a mammogram or ultrasound, a small metal clip (or marker) is placed in the breast where the biopsy has been taken. This is so the area can be found again if a further biopsy or surgery is necessary.
If another procedure isn’t needed, the clip can be safely left in the breast. The marker clip is usually made of titanium (the same metal used for joint replacement surgery). It will not set off alarms at airports. If the marker clip is left in and you need to have an MRI (magnetic resonance imaging) scan in the future, you will need to let the doctor know.
These 2 tests are performed in other departments, not in the breast clinic itself.
Wire localisation may sometimes be used when there is an area of concern that cannot be felt but can be seen on a mammogram or ultrasound. After an injection of local anaesthetic, a guide wire is inserted into the breast under mammogram or ultrasound guidance to accurately mark the location. This means a sample of tissue from the precise area can then be removed during an operation under general anaesthetic.