Breast cancer: examinations and diagnosis
If you discover a lump in the chest and / or other possible breast cancer symptoms (such as skin retraction or leakage from the nipple), you should go to the gynecologist immediately. He will first talk to you to keep your medical history ( anamnesis ): he collects background information that helps him to get to the root of your complaint. For example, the doctor asks when you have discovered the symptoms, if you are taking hormones, and if there are cases of breast cancer or other cancers in your family.
Palpation of the breast
Then the doctor will palpate your chest and surrounding areas (like underarms, collarbone ). You can either sit or stand. The arms must either be stretched upward or lifted on the hip as directed by the doctor. When palpating the doctor, for example, puffiness, redness, recoveries and changes in shape of the breast and nipple. He will also press gently on the nipples. So he can determine if secretion exits.
The ultrasound examination (sonography) of the breast is performed lying down. The doctor first applies a colorless contact gel to your skin. This allows the transducer to glide well over the skin. The breast tissue itself and the area in the direction of the armpit are examined. The emitted ultrasonic waves penetrate the tissue and are thrown back depending on the structure (connective tissue, adipose tissue, fluid-filled structures, etc.). This creates on the monitor a two-dimensional image of the various structures in the breast, which the doctor can judge more accurately.
If women under the age of 40 come to the doctor with changes or chest discomfort, ultrasound scanning is recommended as the first imaging procedure. Only if necessary, an additional X-ray examination of the breast (mammography) is performed, for example in the case of an unclear finding. The reason: In younger years, X-rays can damage the tissue more severely than in older age. In younger people, the cells divide namely faster than older ones. As a result, there is a greater risk of more damaged cells due to radiation. These can easily mutate into cancer cells than healthy cells.
By means of an X-ray examination of the breast (mammography), precursors and early stages of breast cancer can be better detected than by ultrasound . The chest X-ray is associated with radiation exposure. Therefore, it will only be done if the benefit outweighs the potential risks. According to experts, this is the case for women over 40 years of age : the risk of disease is higher in them than in younger women. For this reason, if breast cancer is suspected, mammography is preferred as an imaging test method. If the breast tissue of the woman is quite dense, the ultrasound is used in addition.
In women between the ages of 50 and 69, mammography is even routinely recommended for the early detection of breast cancer. Every two years, women of this age can go to mammography at the expense of the health insurance company ( mammography screening ). In this age group, the risk for breast cancer is particularly high. Therefore, a regular X-ray examination of the breast even without specific cancer suspicion is useful.
You can read more about the course, informative value and risks of chest X-ray in the article Mammography .
Magnetic Resonance Imaging (MRI)
In the magnetic resonance imaging or magnetic resonance imaging (MRI) contrast agent is injected into a vein first. Then the breast tissue is layered using magnetic fields. It will be very detailed images created on which even the smallest changes can be seen.
However, MRI is not routine in breast cancer diagnostics. The examination is very accurate and does not involve radiation exposure (unlike X-rays ). However, it also has disadvantages: Among other things, MRI also shows tissue changes that turn out to be harmless after further investigation. The affected women are therefore unnecessarily worried.
Therefore, MRI is only used in certain cases for breast cancer diagnostics. These include, for example, the following situations:
Standard examinations (ultrasound, mammography, tissue sample) could not safely clear the suspicion of breast cancer.
Standard studies could not clearly show how far the tumor has spread in the healthy tissue.
The removal of a tissue sample is not possible or very difficult (for example in the case of an unfavorable position of the supposed tumor or in the case of several suspicious tissue sites).
Due to breast implants, normal mammography is difficult.
The patient has close relatives with breast cancer, so carries a hereditarily increased breast cancer risk.
Not every tissue change in the breast is malignant. This can only be determined with certainty by a biopsy : After local anesthesia, the doctor takes a small tissue sample of the conspicuous area. In the laboratory, it is examined histologically. If it is really cancer, it also determines how degenerate the cells are already compared to healthy tissue and whether they have many binding sites for hormones (ie hormone-dependent growth). This is important for therapy planning.
Note: Tissue removal is usually performed on an outpatient basis. A hospital stay is usually not necessary.