The best methods for diagnosing breast cancer
Breast cancer is one of the most common types of cancer. However, if the disease is recognized in time, there are chances for successful treatment and recovery, and they are very high.

Everyone knows that every year (or even twice a year!) Women should undergo a preventive examination by a gynecologist and mammologist. Timely identified female diseases allow you to start the necessary treatment as early as possible, while maintaining a quality and comfortable life.

Together with the experts, we reviewed the main ways to detect breast cancer, from self-examination at home to a biopsy.

Self inspection

Diagnosis of breast cancer begins at home, namely with a self-examination.

  1. First, pay attention to the underwear – are there any traces of discharge on it – brown, green, bloody1.
  2. Then stand at the mirror and take a look at your breasts – if the shape and volume of the mammary glands have changed.
  3. Check the skin on the mammary glands – how elastic it is, whether it is going into a fold. Pay attention to the color of the skin, if there are any redness and swelling.
  4. Examine each breast carefully and carefully. Are there areas resembling “lemon peel”.
  5. Press lightly on the nipple to see if there is any discharge.
  6. It is best to conduct an inspection in the shower with a soapy hand. For example, you can put 4 fingers together and examine the mammary glands in a circular motion, moving from the periphery to the center. Do not forget about the axillary lines and armpit areas, where you can often find enlarged lymph nodes.

– It is necessary to examine the breast in the first phase of the menstrual cycle. But every day it is not necessary to conduct an inspection, otherwise the fingers simply will not be able to feel the difference whether a bump has appeared or not. Even better, when you come to the gynecologist, and the doctor also examines the mammary glands, says Gulnur, an oncologist and mammologist Nigmanova.

Examination at the mammologist

Women under the age of 40 should have an annual preventive examination by a mammologist, an ultrasound of the mammary glands, and ideally an MRI of the breast with contrast.

Women over 40 should be seen by a specialist twice a year2 and undergo mammography in two projections.

— It has been proven that in a comprehensive examination, mammologists diagnosed breast cancer much more often and more accurately than radiologists and ultrasound doctors. This indicates the accuracy of the clinical examination method.3, – is talking oncologist Dina Sakaeva.

It is necessary to visit a mammologist:

  • during the appearance of the first menstruation, when the mammary glands begin to grow;
  • before conceiving a child. For example, in girls with a small size of the mammary glands, fibroadenoma is often observed, which is not treated with medication and must be removed;
  • during feeding, if lactostasis appears, problems with the nipples;
  • 6 months after the end of breastfeeding. You also need to undergo an ultrasound of the mammary glands.

Mammography

Until the age of 40, women are usually not prescribed mammography, only ultrasound of the mammary glands. But after 40 years, it is mammography that can detect breast cancer at an early stage and reduce the mortality rate by up to 50%.4.

Mammography is an x-ray examination with a low radiation exposure to the body. Its essence lies in the fact that an image is displayed on the screen, which can be enlarged and printed.

It is desirable to carry out mammography in the first phase of the cycle – from the 5th to the 10th day of the cycle. An examination is prescribed for preventive purposes, as well as for complaints – seals and pain in the mammary glands, unusual discharge from the nipples. Mammography is not performed during pregnancy and lactation.

Ultrasound of the mammary glands

Ultrasound of the mammary glands, unlike mammography, can be done for both pregnant and lactating women.

It is better to conduct an ultrasound scan on the 5-10th day from the onset of menstruation. But if you have complaints – pain and seals – you should not hesitate to contact a doctor.

Ultrasound of the mammary glands does not require special preparation, does not take much time, and you get the result right away. At the same time, the procedure has no contraindications, and it can be carried out exactly as many times as necessary.

MRI of the mammary glands

One of the most informative methods for diagnosing breast cancer is breast MRI with contrast. This type of examination does not carry radiation exposure and helps to identify neoplasms.

The study is carried out with intravenous contrast and allows you to analyze the nature of the identified changes in the mammary gland. Malignant tumors are characterized by an infiltrating (penetrating) type of growth, irregular shape, asymmetry of the mammary glands, uneven fuzzy contours5.

MRI of the mammary glands should be carried out strictly from the 5th to the 12th day of the cycle. If a woman is in menopause, then any day.

If radiation therapy was performed, then MRI is performed no earlier than six months later. If there was an operation, then an MRI can be done after 3 months.

Biopsy

During a biopsy, specialists take a small piece of breast tissue to analyze and identify malignant cells.

A biopsy is usually ordered if a mass is found in the breast, or if an MRI/mammogram reveals a “suspicious area” that needs to be further examined.

Assays

But tests that will detect breast cancer, unfortunately, do not exist. Even in the indicators of a blood test, there will be no deviations, especially at an early stage. 

Tumor markers

Many laboratories conduct research to identify the two main breast cancer markers. These are CA 15-3 and cancer embryonic antigen (CEA). However, testing for tumor markers is useless if the goal is to detect cancer at an early stage.

— The role of tumor markers in the primary diagnosis of breast cancer has not been established. Therefore, it makes no sense to take this analysis “just in case,” says oncologist Dina Sakaeva.

genetic test

Genetic testing allows you to find out if your DNA contains the genes responsible for hereditary breast cancer. Mutations in the BRCA1 and BRCA2 genes significantly increase the development of breast cancer.

According to oncologists, a similar test should be done for those women who had close relatives – mothers, grandmothers, sisters and aunts – who had breast cancer. Also, if a woman has a mutation, her relatives also need to be examined.

Popular questions and answers

How breast cancer manifests itself, what symptoms you need to pay attention to, as well as other popular questions, the doctor of the highest category of palliative care, oncologist (mammologist), surgeon Gulnur Nigmanova,

What are the symptoms of breast cancer?

– With breast cancer, pain usually does not happen. Pain can only occur in the bones and during the decay of the tumor.

1. A woman can feel a lump, which can be quite large. Unlike fibroadenoma, which can “roll” in the breast, a malignant tumor is immobile. This is the main difference.

2. Symptom of “lemon peel”. The mammary gland in appearance resembles a lemon. Due to the deformation of the glandular tissue, individual sections may swell or, on the contrary, go inside.

3. Inverted nipple. If you have always had a normal nipple, and suddenly it retracted, then this is an occasion for immediate medical attention.

4. Bloody discharge from the nipple. Light discharge occurs with pituitary adenoma and with increased prolactin, after abortion and after lactation – this is the norm. Brownish-greenish discharge appears with cystic mastopathy. Purulent – when the cyst is festering or with non-lactational mastitis. For any discharge, you need to consult a specialist, and especially for bloody ones.

How to determine the stage of breast cancer?

– If a woman finds a seal in the mammary gland and an enlarged regional lymph node (most often it is a bump in the armpit), or a tumor on the mammary gland is very small, it is even impossible to find it, but a large lymph node, this indicates a great aggression of the tumor. So, this is stage 2 or 3 breast cancer.

Finally, the degree of breast cancer can only be judged after a comprehensive examination. A scintigraphy is prescribed to detect bone metastases, the lungs and lymph nodes are checked. With the spread of metastases, we are already talking about stage 4 breast cancer.

How long does it take for breast cancer to develop?

– Several years may pass from the moment of damage to the glandular tissue and the formation of a cancer cell to a tumor with metastases. Indeed, the first time the tumor may not be determined. Therefore, it is very important to undergo regular examinations with a mammologist in order to identify the disease at an early stage and begin treatment.

Sources:

  1. Clinical semiotics and preoperative surgical diagnosis of breast cancer. Kolyadina I.V., Komov D.V., Poddubnaya I.V., Danzanova T.Yu., Kostikova L.A., Sinyukova G.T., Banov S.M. Russian journal of oncology, 2013
  2. The role of clinical breast examination in cancer screening in women. Gerashchenko Ya.L., Chernichenko I.I., Khadzhieva E.D., Lonshakova A.S. Research’n Practical Medicine Journal, 2018
  3. Experience with digital mammography. Korzhenkova G.P., Dolgushin B.I. Journal “Tumors of the female reproductive system”, 2011. https://cyberleninka.ru/article/n/opyt-ispolzovaniya-tsifrovoy-mammografii
  4. Breast cancer screening: global experience and perspectives. Kolyadina I.V., Poddubnaya I.V., Komov D.V. Russian journal of oncology, 2015. https://cyberleninka.ru/article/n/skrining-raka-molochnoy-zhelezy-mirovoy-opyt-i-perspektivy
  5. Hereditary breast and ovarian cancer. Lyubchenko L.N., Bateneva E.I., Abramov I.S., Emelyanova M.A., Budik Yu.A., Tyulandina A.S. and others. Journal “Malignant tumors”, 2013. https://cyberleninka.ru/article/n/nasledstvennyy-rak-molochnoy-zhelezy-i-yaichnikov

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