- Ultrasound scan
- Fine needle aspiration (FNA) and core biopsy
- Other tests and procedures
- Getting your results
A mammogram is a breast x-ray. You may have a mammogram as part of a national breast screening programme, or if you’ve been referred to a breast clinic by your GP or been called back to a breast assessment clinic following routine screening.
During your appointment, a female mammography practitioner (an expert in taking breast x-rays) will ask you to undress to the waist and stand in front of the mammogram machine. If you’re pregnant or think you may be pregnant, tell the mammography practitioner.
Your breasts will be placed one at a time on the x-ray machine. The breast will be pressed down firmly on the surface by a clear plate. At least two pictures of each breast will be taken, one from top to bottom and then a second from side to side to also include the part of your breast that extends into your armpit. You will need to stay in this position while the x-ray is taken. You may find it uncomfortable but it only takes a few seconds and the compression doesn’t harm the breasts.
Mammograms are not often used in women under 40. Younger women’s breast tissue can be dense which can make the x-ray image less clear so changes can be harder to identify. However, for some women under 40, mammograms may still be needed to complete the assessment.
Some people worry about the amount of radiation used in mammograms. Mammograms deliver a very low dose of radiation (you’d receive a similar amount from flying between London and Australia and back). The dose is monitored and adjusted according to the person’s individual situation. This ensures that the dose remains as low as possible while still providing a good-quality image.
Further mammograms taken at different angles or with magnification are sometimes used to examine particular areas of the breast in greater detail.
Digital breast tomosynthesis (DBT) is another type of mammogram that is being trialled in some hospitals. DBT makes 3D pictures using x-rays. The breast is positioned the same way as when having a mammogram, but less pressure is applied – just enough to keep the breast in a stable position. The x-ray arm rotates and curves around the breast, taking multiple x-ray pictures at different angles. The information is then sent to a computer where it makes the pictures into 3D images (3D mammogram). Each image is a series of pictures of the breast. This makes it easier to see any overlapping breast tissue more clearly.
An ultrasound scan uses high-frequency sound waves to produce an image of the breast tissue. 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 undress to the waist and lie on a couch with your arm above your head. To help gain a clear image of the breast, some gel will be spread over the area of your breast being scanned. The doctor or nurse will use a hand-held scanning 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 will usually be done in addition to mammograms, regardless of your age. They are often used together because they provide different information.
3. Core biopsy and fine needle aspiration (FNA)
Triple assessment is usually all that is needed to make a diagnosis. However, if the previous tests haven’t given enough information to make a diagnosis, other tests may be needed. If this is the case you may be called back at a later date for one or more of the following tests.
Although mammograms are usually the best way of detecting any early changes within the breast, sometimes other imaging techniques may be used as well. This could include:
- An MRI (magnetic resonance imaging) scan: uses magnetic fields and radio waves to produce a series of images of the inside of the breast.
- A CT (computerised tomography) scan, also known as a CAT scan: a type of scan that uses x-rays to take detailed pictures across the body.
Vacuum assisted biopsy
If a previous biopsy has not given a definite result and more breast tissue is needed to make a diagnosis, or if the area of concern is difficult to target, you may be offered a vacuum assisted biopsy. This procedure takes a little longer than a core biopsy and is done using a mammogram or ultrasound for guidance.
After an injection of local anaesthetic, a small cut is made in the skin, through which a hollow probe connected to a vacuum device is placed. Using a mammogram or ultrasound as a guide, breast tissue is sucked through the probe by the vacuum into a collecting chamber. This means that several samples of tissue can be collected without removing the probe.
Sometimes this procedure is used as an alternative to surgery to remove a whole area of breast tissue (called a vacuum assisted excision biopsy).
Inserting a metal marker
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.
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.
If you’d like more information about any of these tests, you can call Breast Cancer Care’s free Helpline on 0808 800 6000 (Text Relay to 18001).
Having investigations for a breast problem can be a worrying and stressful time.
The staff in the breast clinic will know that you want results as soon as possible and your specialist may be able to tell you what they think the outcome might be. However, the results of all the investigations you’ve had are usually needed before you can be given more detailed information. If you’re anxious about your results or would like to talk to someone about any concerns you can call our free Helpline on 0808 800 6000.
The breast clinic will let you know how and when you’ll get your results. You’ll usually be given an appointment to return for your results, but occasionally your results may be given in a phone call or a letter. A summary of your breast assessment and results will then be sent to your GP, and a copy of this letter will usually be sent to you.
It may be a good idea to have your partner or a close friend or relative with you when you go to your appointment to get your results. That way you can be sure there is someone there for support, should you need it. They may also think of questions that hadn’t occurred to you and remember things you may forget. It may be useful to take a notepad and pen to write down any information you want to remember later.
If you have normal breast changes or a benign breast condition
For most women, breast assessment will show normal breast changes or a benign breast condition. In this case the specialist will explain what it is and whether you need any treatment or follow-up.
Benign breast conditions are common and there are many different types. We have information about individual benign breast conditions.
Even if you’re found to have normal breast changes or a benign condition, it’s still important to be breast aware and go back to your GP if you notice any other changes in your breasts, regardless of how soon these occur after you get your results.
If you are given a breast cancer diagnosis
If your results show that you have breast cancer you will be introduced to a breast care nurse who will talk to you about your primary breast cancer diagnosis and treatment. She will give you support and written information and can be a point of contact for you throughout your treatment and afterwards.
If you are diagnosed with breast cancer you may find our Breast cancer and you: coping with diagnosis, treatment and the future booklet useful.
You or your family and friends can also call the Breast Cancer Care Helpline on 0808 800 6000 or visit our online discussion Forum for information and support.