What investigations will the doctor suggest?
It is recommended that the doctor uses an approach known as the triple test to find the cause of a breast change. However, it should be noted that many women with breast changes will not need all of these tests.
The triple test includes:
- clinical breast examination and taking a personal history
- imaging tests i.e. mammography and ultrasound
- non-surgical biopsy; i.e. a fine needle aspiration and core biopsy.This is when a sample of cells or tissue is extracted from the lump
Most women show no signs of cancer on any of the tests. The small number who do show possible signs of cancer on one or more of the tests may be advised to see a surgeon and may have an open surgical biopsy.
How accurate is the triple test?
If used on their own, none of the tests will be able to find all cancers. However, if all tests are done and none show signs of cancer, it is very unlikely that cancer will be present. If all three tests are performed, more than 99.6% of cancers will be found by one or more of the tests.
Clinical breast examination
The doctor can tell much about the likely causes of a breast change from this test, which provides a thorough examination of the whole breast area, including the armpits and up to the collarbone.
After the woman has removed all clothing from the upper half of her body, the doctor may look at her breasts while she is seated or standing to see whether any changes are visible. Following this, she may be asked to lie down, so the doctor can examine both breasts and nipples as well as the armpits. If necessary the doctor will organise a referral to a surgeon.
Imaging tests
The next step may be an imaging test, which is mammography or ultrasound. For some women, both tests may be needed to gain enough information about the breast change.
Non-surgical biopsy
If a woman has a lump or lumpiness which is not caused by hormonal changes or a cyst, she may have a fine needle aspiration biopsy or a core biopsy. This is the third part of the triple test. In these tests, a small sample of the cells from the lump or area of breast change are examined to determine the types of cells that are present.
Open surgical biopsy
If any of the tests show signs of cancer, the woman will be referred to a surgeon and she may have a surgical biopsy. This test is used to provide the most accurate information about whether a cancer is present or not. An open biopsy is usually performed at a hospital or a day surgery clinic, in most cases under a general anaesthetic.
