Diagnosis of breast cancer
Most women (approx. 75% of all women with breast cancer) notice a lump in the breast themselves as the first sign of breast cancer and then visit (consult) their gynaecologist. In other patients, breast cancer is discovered, for example, during a preventive examination.
The doctor treating the patient must first find out about the patient’s symptoms and risk factors (anamnesis). Then both breasts must be examined (inspected) and palpated for possible lumps. If the doctor finds anything abnormal, a mammography and/or mammosonography of the breast is performed.
The mammography is a special X-ray of the breast. It is carried out during the early detection of cancer or if breast cancer is suspected. Conspicuous cell clusters in the breast can be easily detected.
Mammosonography is a special type of ultrasound examination (sonography) of the breast. It is usually performed as a supplement to mammography. Magnetic resonance imaging (MRI) of the breast (breast – MRI breast) is rarely used as an examination method, as this procedure misses 60 – 70% of all precancerous stages, for example.
However, magnetic resonance imaging of the breast can be useful in distinguishing a tumor from a scarred breast alteration. And even if cancer cells are found in lymph nodes of the armpit, but neither mammosonography nor mammography shows a visible tumor in the breasts, magnetic resonance imaging of the breast is a helpful examination to detect breast cancer. For a more detailed examination of a tumour, a tissue sample (biopsy) can be taken from the tumour with the help of a special needle (minimally invasive fine needle puncture).
This tissue sample can be used to identify the type of tumour and to determine whether it is malignant or benign. If the tumour is malignant, it is also possible to determine the type of breast cancer. .
If a malignant tumour has been detected by means of the above-mentioned examinations, it makes sense to examine other organs in which the cancer has settled for cancer (screening). This involves an X-ray of the chest (X-ray thorax), an ultrasound examination of the liver (liver sonogarphy), a gynaecological examination and a bone scintigraphy. A bone scintigraphy is an imaging procedure to show tumours or inflammations with nuclear medical methods.
More precisely, it means that a certain substance, in which so-called radionucleotides are present, is injected into a vessel of the patient. In a bone scintigram, these radionucleotides accumulate specifically in the bone, directly in the cancer or inflammation cells. They emit bundled gamma rays, which can be measured with a special camera (gamma camera) and converted into an image.
If the patient now has cancer cells in the bone that have settled out of the breast cancer, this can be seen with the help of such a scintigraphic image. . Mammography is a procedure that works with X-rays and can reveal microcalcifications in the breast.
It is part of the early detection program of breast cancer prevention. From the age of 50, every woman is recommended to have a mammography every two years. In addition, mammography is used in women over 40 to clarify abnormal palpation findings.
An important part of the early detection of breast cancer is the instruction of patients to palpate the breast on their own. Before starting to palpate, the breasts can also be looked at from the sides. Newly appearing asymmetries indicate changes in the tissue.
One therefore looks at indentations, protrusions or changes in the skin. In addition, one also looks at the nipples, as there is also breast cancer at this point. The palpation examination is carried out once with the arms hanging and then with raised arms.
You should make sure to palpate all areas of the breast. The best way to do this is to divide the breast into four quadrants and to examine each quadrant in turn. The palpation is always performed with two hands.
One hand palpates and the other works as an abutment. It is important to always palpate both breasts in side by side comparison. Besides the breast, the most important lymph node regions should also be palpated.
These include the armpits and the areas above and below the collarbone. Here, attention should be paid to enlarged lymph nodes, which can be palpated spherically. Breast cancer screening includes structured and regular check-ups with the aim of detecting early stages of breast cancer.
For women without risk factors, the early detection programme for breast cancer begins at the age of 30. However, many gynaecologists also carry out a palpation of the breast as part of the gynaecological examination and instruct patients to examine themselves. From the age of 50 until the age of 69, a biennial mammography is part of the early detection, in addition to the palpation examination.
Sonography or an MRI of the breast is only used in special cases and is not standard. If there is hereditary breast cancer in the family, an intensified early detection programme is carried out. As a rule, one starts with the annual palpation examinations from the age of 25 and mammography from the age of 40.
There are also family constellations in which mammography may be indicated from the age of 30. Especially in this group of patients it is also important that from the age of 25 onwards, in addition to the palpation examination, a sonography and an MRI are carried out annually. For men, there is no breast cancer screening as yet. For persons at risk, structured early examinations can be useful.