This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on May 5, 2022.
Regular breast cancer screenings are important because they may allow for early detection of the disease. This means breast cancer treatment may start earlier, when the disease is easier to treat.
During the breast cancer diagnosis process, the care team may perform a variety of tests, depending on several factors:
The care team may also recommend that women see other doctors, such as a surgeon or breast expert, during the diagnostic process. This does not necessarily mean they have cancer—just that the care team believes further analysis by an expert would be helpful.
Various care team members will be involved in the early detection and diagnosis process. Depending on a woman's symptoms, this may include a general practitioner, gynecologist, dermatologist, radiologist, medical oncologist and/or other providers.
Various imaging procedures are used to diagnose breast cancer, including:
Ultrasound: This imaging test detects even slight abnormalities in dense breasts and can help determine whether a lump is a cyst (sac containing fluid) or a solid mass. Ultrasound may also be used to locate the position of a tumor in order to guide the doctor during a biopsy or aspiration procedure. For example, in some cases, surgical oncologists will use an intraoperative ultrasound during a lumpectomy to mark out the boundaries of the tumor prior to its removal.
Before an ultrasound begins, a clear gel will be applied to the breast. Then, a small probe will be placed on top of the gel and moved over the breast area. The probe creates a picture of the inside of the breast and sends it to a computer screen. If there is a suspicious area or lump in the breast, the ultrasound images can help the doctor take a closer look at the area. It is not a painful procedure, but the pressure of the probe may feel uncomfortable. It may be done and performed in the doctor’s office.
Mammography: Full-field digital mammography acquires sharp, digital images of the breasts with similar radiation exposure to traditional mammography. Once the digital images are received and transmitted to a high-tech, digital mammography workstation, a radiologist analyzes the images to determine the location and extent of the disease.
Mammograms take around 20 minutes to complete. Before the test begins, the patient will receive a wrap gown to cover her upper body, since she'll need to undress above the waist. Mammograms are performed by a mammographer—someone who is trained to operate the X-ray machine. The machine has two plates that compress or flatten the breast to take a better picture. Once the patient is ready to start, the mammographer will place her breast between the plates. Then, the upper plate will be lowered on top of her breast. The patient's breast will be compressed for a few seconds while a picture is taken. After the first picture, her breast will be repositioned, and the process will be repeated to get images of the whole breast from different angles. Each time the breast is compressed, the patient may feel some discomfort or even pain. However, each compression only lasts a few seconds.
MRI (magnetic resonance imaging): With this technology, radiofrequency waves create detailed cross-sectional images of the breasts. An MRI may help identify breast tumors in addition to those detected by a mammogram. Patients can get an MRI scan at a hospital or a clinic. The patient will likely change into a hospital gown before the test and remove any metal objects, such as jewelry or hair clips, from her body. During the test, she’ll be lying on her stomach on a table while her breasts hang down into an opening. The table will then slide into a narrow tube where the scan will be taken. The patient will need to stay very still while the images are being made. The test is painless and may take up to 60 minutes.
MRI-guided breast biopsy: With this minimally invasive, image-guided procedure, radiologists use MRI technology and targeting software to locate and remove cells from a suspicious area in the breast for diagnosis and treatment planning.
PET/CT scan: This advanced nuclear imaging technique combines PET and computed tomography (CT) into one machine. A PET/CT scan reveals information about both the structure and function of cells and tissues in the body during a single imaging session.
Before a PET/CT scan, an IV that injects a small amount of a radioactive substance will be placed into one of the patient's veins. This substance is often called a “tracer,” because it helps reveal cancer in the body. The PET scan shows where the tracer is concentrated (and thus where the cancer is likely to be), while the CT scan takes X-ray images of the body from different angles. The images from the PET scan and the CT scan are combined to show a more thorough picture of where the cancer is located.
The radioactive substance takes around 30 to 90 minutes to spread throughout the body. The patient may need to drink a contrast liquid (or she may receive it through an IV) to help give the images more definition. Right before the test, the patient will be asked to go to the bathroom to empty her bladder.
The scan is painless and only takes around 30 minutes, but the entire appointment may take up to 3 hours, considering the time it takes for the tracer to absorb.
Once the patient's bones have absorbed the substance, she will lie on her back underneath a large scanning camera that moves around her body, taking pictures of where the tracer is concentrated. It takes between one to four hours for the patient's bones to absorb the tracer, and a whole-body scan takes around one hour. The patient will need to hold still for the entire scan, but it isn’t painful.
Digital breast tomosynthesis: Tomosynthesis is similar to a standard mammogram in that it uses X-ray technology and applies the same amount of pressure to the breast. But rather than providing two views—from top to bottom and side to side—the 3-D approach captures multiple views from a variety of angles in seconds.
Some common biopsies used to help doctors diagnose breast cancer include fine-needle aspiration biopsy, which uses a small needle; core needle biopsy, which uses a larger needle; MRI-guided biopsy; or surgical biopsy, in which all or part of a lump is removed and checked for cancer. Fine-needle aspiration and core needle biopsies may be performed using certain imaging tests, such as ultrasound, breast MRI, mammography or CT scan.
A sentinel lymph node biopsy may first be performed to determine whether cancer has spread to the lymph glands under the arm. A radioactive substance and/or a dye is injected directly under the skin of the breast. The first set of lymph nodes are then removed and reviewed by a pathologist to check for the presence of cancer cells.
The type of biopsy used will depend on several factors, including the size of the suspected tumor, where it is in the breast and whether there's more than one. The patient's medical history and personal preferences will also play a role in the decision.
Biopsies that use a needle are outpatient procedures and are typically performed using imaging guidance. Some needle biopsies may be performed in the doctor’s office. The patient will likely receive local anesthesia to numb the breast, but she'll be awake during the process. During the procedure, a needle is placed through the skin into the suspicious area, and fluid or tissue is suctioned into a syringe. Core needle biopsies are used more often because they remove more tissue compared to a fine needle aspiration biopsy.
Surgical biopsies involve making an incision in the skin on the breast to remove tissue. These biopsies are more likely to be performed in a hospital’s outpatient department. The patient will receive sedative drugs to make her calm and drowsy during the procedure and a local anesthetic to numb the breast area. Alternatively, the patient may go under general anesthesia to stay in a deep sleep during the procedure. Stitches and a clean dressing are then applied to the area after the procedure to help with wound healing on the skin.
In some cases, certain types of lab tests, called genomic tests, are used to learn more about the genetic makeup of breast cancer cells. Genomic tests can help the care team examine specific genes and proteins in the cancer cells and develop a treatment plan that is specifically geared to disrupt and fight the specific cancer. The information can also help women and their doctors understand the risk of cancer recurrence.
These genomic tests require a sample of the tumor that has been removed during biopsy or surgery. Then, specialists examine the tumor sample and its genetic profile in a laboratory. Typically, if the patient needs to have the genetics of her tumor tested, she will have already undergone biopsy or surgery and will not need an additional procedure to obtain the sample.
Advance genomic testing: Genomic testing examines a tumor on a cellular level to look for the DNA alterations that are driving the growth of cancer. By identifying the mutations that occur in a cancer cell's genome, doctors can better understand what caused the tumor and tailor treatment based on these findings.
Oncotype DX®: The Oncotype DX test (also called the 21-gene test) is used to determine whether breast cancer chemotherapy is likely to benefit women with early-stage breast cancer. This lab test also helps the cancer care team to know the likelihood of disease recurrence. With this information, the patient and her care team are better able to make more informed decisions about breast cancer treatment.
MammaPrint® and Blueprint®: The MammaPrint and BluePrint genomic lab tests are used to decode a breast tumor's unique traits to help us craft a targeted treatment plan specific to each patient’s individual needs. MammaPrint is used to determine the risk that a patient’s cancer will return. BluePrint is used to determine which of the tumor’s mutations are dictating the cancer’s behavior. When used with the MammaPrint assay, BluePrint narrowly defines each tumor into a subtype classification, affording the doctor a clearer picture for a more precise treatment strategy.
Interventional radiologists—physicians who specialize in minimally invasive, targeted treatments—use specific imaging and radio wave tests to detect metastasis in various parts of the body. For example, for breast cancer patients with metastasis to the liver, they may use microwave ablation, a procedure that uses small devices called antennas to send heat to cancerous cells.
The care team may perform a bone scan to reveal whether breast cancer has spread to the bone. By capturing images of bones on a computer, bone scans may reveal important information, such as the location of the bone metastasis. A bone scan is similar to a positron emission tomography (PET) scan in that it starts with an injection of a radioactive substance (tracer) that helps highlight if and where cancer is located. Unlike PET scans, bone scans focus specifically on detecting cancer within the patient's bones.
Other types of imaging tests, such as PET scan or MRI may be used to determine if cancer has spread to other locations in the body.