When you feel a lump or have a concern that you have developed a breast symptom, the first way to put your mind at rest is to know that more than 70% of all patients with breast problems do not have cancer. The only way to get an answer, is to be seen by a specialist who should ensure correct imaging and diagnosis.

The only way to get an answer, is to be seen by a specialist who should ensure correct imaging and diagnosis.

What will happen when I am seen by a doctor?

When you visit a general practitioner or breast specialist, you are not just going to discuss your current problem, but chat about your general health and history too. It is important to identify risk factors and potential health issues for the future, not just focus on one part of your health. The way to know exactly what type of lump you have or the cause of your symptom is to have your general practitioner or breast specialist carry out triple assessment. This means that every lump or symptoms is investigated and managed in the same rational manner.

What is a C.P.R triple assessment?

C- Clinical examination

You doctor will spend some time examining you in order to determine if there is an abnormality. They will look if there are any visible breast changes you can see such as skin thickening, nipple changes, or dimples in the breast. After that your doctor will physically examine the breasts (also known as a clinical-breast-examination), in the same way as in self-breast-examination. They will feel into the axilla and all over the breast looking for lumps or painful areas. It is also important to look at the nipple carefully, looking for any discharges or abnormalities. Often your doctor will do a full clinical examination to check for any other changes or abnormalities, including taking your blood pressure.

If you do have a lump or abnormality identified, your doctor will discuss what this means. No doctor has X-ray fingers, so any clinical-breast-examination is always accompanied by imaging (radiography) which is the next step.

R- Radiology examination

This is imaging done by a specialist radiologist with a double read by a second radiologist to ensure nothing is missed. Normally this includes a mammogram with at least two views (but sometimes more) and an ultrasound of the breast and armpit. Often in women under 35 years the breast is often too dense to rely on mammograms to see the problem so an ultrasound is done instead. Newer methods of diagnosis such as MRI scan may also be useful in some cases.

P - Pathological diagnosis

If there is a lump present, the radiologist may wish to do a core needle biopsy. This is best done by the radiologist because they use X-ray or sonar guidance. The old technique of Fine Needle Aspiration (FNA) should not normally be used because it can be inaccurate and not give the doctor enough information. It is also rare to require a full surgical biopsy in theatre and it is often not the best method of diagnosing cancer as it affects further treatment.

This sample will be sent to a pathologist who will cut the sample into small slices and stain them specially to allow easy identification of any abnormalities or cancers.

How soon will I be told if it is cancer?

The specialist breast surgeon or radiologist may be concerned about the lump or mass they see, but no diagnosis can be made for certain without a tissue sample taken by biopsy. This takes at least 48 hours to test.

The most important thing to remember is that Breast Cancer is not a death sentence, nor is it an emergency. By the time a cancer is palpable (at 1cm) it has been present in your breast for at least five years.

There is never a requirement for an emergency mastectomy, and sometimes the best treatment for Breast Cancer is to begin with chemotherapy rather than considering immediate surgery.

So even if there is cancer present, you have time to consider your options, follow advice or seek another opinion.

Even if there is cancer present, you have time to consider your options, follow advice or seek another opinion.

Breast Cancer staging

Patients often ask at what stage their cancer has been diagnosed and how advanced it is. Although this might seem very important, in actual fact the character of the cancer, the way it behaves and reacts to treatment, is more important. For instance, an early stage but aggressive cancer may progress more quickly than a large, low-activity tumour.

Staging is determined on clinical and laboratory findings. Staging systems are used to classify Breast Cancer, so that the doctor can treat the disease with a logical approach and all Breast Cancers doctors have a common premise on which to base treatment plans. The most commonly used staging system is the TNM staging system. It allows doctors at particular centres to compare their results with other centres all over the world. Thus treatment regimens in South Africa can be compared with those in the United Kingdom and United States of America.

The most commonly-used staging system is the TNM staging system, with T referring to tumour size, N referring to nodal status and M being used to determine metastatic disease which is when cancer has spread beyond the breast and regional lymph nodes to the rest of the body.

Metastases are little islands of tumour cells that have spread from the primary cancer and taken root in distant tissues and organs. It is these metastases that eventually cause death. Doctors detect metastases with various methods.

Part of the staging is to perform certain tests to determine whether the cancer has spread (M):

  • Chest X-ray for lung spread
  • Bone X-ray and scan for bony spread
  • Brain scan for brain metastases (MRI)
  • Abdominal ultrasound (sonar and CAT scan for liver spread)
  • Blood tumour markers (these should be used as a serial assessment, not as individual values).

There are four stages of cancer

Stage I one
Stage 1 usually means that a cancer is relatively small and contained within the organ it started in.
stage 2
Stage 2 means the breast cancer is growing, but is still contained in the breast or growth has only extended to the nearby lymph nodes.
Stage 3
Stage three cancers are locally advanced (large Breast Cancers greater than 5cm)
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Stage four cancers have spread to elsewhere (M+).

It is your patient right to know as much as you want about your cancer and to ask about new treatments. Remember that your time with your doctor is just that: YOUR TIME so take as much time as you need during a consultation. It is your body and your life so become involved with your health.