Diagnosis of breast cancer

The diagnosis of breast cancer can trigger strong feelings of uncertainty and despair. The initial shock is quickly followed by existential fears: How serious is my condition? Can my cancer be cured? Do I have to undergo stressful chemotherapy? Will I lose my breast? These feelings of being overwhelmed and helpless are understandable, but through all the fear you must not forget: breast cancer is curable in the majority of cases, if it is diagnosed early and treated properly. When a malignant tumour is diagnosed, the top priority is to remain calm and refrain from making any snap decisions. You have enough time to clarify the details of your individual case, study all of the medical options and form a clear picture of your own needs. If in doubt, seek a second opinion from an onco-plastic surgeon, and take along a good friend or family member to your appointments. Through all the fear you must not forget: breast cancer is curable in the majority of cases, if it is diagnosed early and treated properly.

The three objectives of the right breast cancer treatment

The most important aspect in any breast cancer treatment is always the complete removal of the tumour. If breast-conserving surgery is not possible and the breast must be completely removed, the woman affected should be able to get as clear a picture as possible of her options by means of comprehensive advice and timely information. Even if it is important to act quickly, there is enough time for a thorough evaluation and to weigh up the pros and cons of the various treatment methods. The right breast cancer treatment is the one that is 1) the most effective oncologically; 2) will lead to the best cosmetic result and 3) will lead directly to the goal – the end of treatment – without any unnecessary surgery.

Remember:

• Breast cancer is not an emergency. Do not rush.
• You have enough time for a thorough investigation. Do not make any hasty decisions.
• Make sure you are well informed.

Further investigations

If there is any suspicion of breast cancer, a mammogram will be performed to clarify the situation, along with an ultrasound examination if necessary. If this does not provide satisfactory information, an additional fine needle aspiration (removal of individual cells), a punch biopsy (removal of tissue) or magnetic resonance imaging (MRI) will be performed.

Mammogram

A mammogram is a special x-ray of the breast and is a standard screening technique. It enables display of the glandular tissue on two to three levels. This allows the radiologist to detect fine differences in the density and composition of the tissue. Even the presence of the tiniest calcium deposits, which is frequently the first sign of breast cancer, can be identified. To produce the images, the breast is placed between the x-ray tube and the film plate and then carefully compressed.

Ultrasound

A supplementary ultrasound examination may be performed to confirm the results of the mammogram. This provides the doctor with two-dimensional images that offer a spatial view of the size, shape, structure and composition of the breast, soft tissue and vessels.

MRI

MRI, or Magnetic Resonance Imaging, is a technique for displaying internal organs and tissue. It uses magnetic fields and radio waves. During the procedure, the patient lies on a so-called “bore” inside the machine. The advantage of this technique is that it provides very accurate and detailed images of body tissue. Even minimal changes in the body can be detected using this method. This is why magnetic resonance imaging is used when the diagnosis of breast cancer is unclear.

Fine needle aspiration

Fine needle aspiration is a technique to extract cellular material from certain tissue sections. The doctor inserts a hollow needle into the tissue from which a sample is to be taken. The sample is then examined under a microscope in the laboratory. Experienced cytologists can make a relatively accurate assessment of the cells, confirming suspected diagnoses from previous investigations.

Punch biopsy

In the case of a punch biopsy, a thin cylinder, usually controlled by ultrasound, is used to remove and examine tissue samples. This method is somewhat more painful, but it produces more detailed results than a fine needle aspiration and is therefore used when the findings of previous tests are inconclusive.