Breast screening results and assesment

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1 Breast screening results and assesment This information is an extract from the booklet, Understanding breast screening. You may find the full booklet helpful. We can send you a copy free see page 9. Contents How do I find out my result? What happens at the assessment clinic? Possible results DCIS Breast awareness How do I find out my result? You and your GP should receive the results of your mammogram (breast x-ray) in writing within two weeks. If you don t hear anything by this time, you can phone your breast screening unit and ask them to check your results. 19 out of 20 women will have a normal result and will be invited for a mammogram again in three years time, until they are older than 70 (73 once the age range is fully extended in England). If you have a normal result you won t need to go back for more mammograms until you receive your next invitation from the screening clinic in three years time. If you find any changes in your breasts in the meantime you can go to your GP who can arrange tests for you. There is information about how to be breast aware and the changes in your breasts that you should report to your GP on pages 7-9. Macmillan and Cancerbackup have merged. Together we provide free, high quality information for all. Questions about cancer? Ask Macmillan Page 1 of 9

2 About 1 in 20 women (5%) who go for screening are asked to go to a breast assessment clinic for further tests. This may be because a possible problem with the breast tissue was seen on the mammogram. This problem may not be a cancer, as there are many breast conditions that can show up on a mammogram. Approximately 1 in 8 women who have an abnormal result will have breast cancer, which means that 7 out of 8 won t have breast cancer. Occasionally, the need for more tests is due to technical reasons (for example, if the mammogram picture was not clear enough). Around 2 women in every 100 (2%) are called back for technical reasons. What happens at the assessment clinic? Breast assessment clinics are based in hospitals or at a screening centre, and you will have more tests carried out there. There will always be a specialist breast care nurse at the assessment clinic. They can give you advice, information and support while you are having your tests. You may have a range of emotions, from anxiety to fear. It s important to remember that about 7 out of 8 women who are asked to go to the assessment clinic will find that their tests show that there is nothing wrong. Some women might have a benign (non-cancerous) breast condition. These women will be asked to attend again for their routine mammogram in three years time. Only 1 in 8 women who are asked to go to an assessment clinic will have breast cancer. The tests might include any of the following: A clinical examination in which a doctor or nurse practitioner will very carefully examine and feel your breast tissue and the lymph nodes under your arms and in your neck. More mammograms may be taken at different angles or using magnification. A breast ultrasound, which uses sound waves to build up a picture of the breast tissue. Ultrasounds can often tell whether a lump is a solid lump (made of cells) or is a fluidfilled cyst. Page 2 of 9 Questions about cancer? Ask Macmillan

3 You will be asked to take off your clothes from the upper part of your body and lie down on a couch. An ultrasound specialist will then put gel onto the breast and gently rub a small device, like a microphone, over the area. This shows a picture of the internal tissue of the breast on a screen. Ultrasound scans are usually painless and only take a few minutes. Areas of scar tissue or lumpiness in the breast may be sore or painful when the ultrasound probe is moved over them. Let the person doing the ultrasound know if it is painful for you. Needle (core) biopsy A doctor uses a needle to take a small piece of tissue from the lump or abnormal area. A local anaesthetic is injected into the area first to numb it. Once the anaesthetic has taken effect, a small cut is made in the skin of the breast. The doctor will then insert a needle through the cut and remove a section of tissue measuring about 20mm x 2mm (¾ x 1/5 inch). This isn t painful but you may feel a sensation of pressure. Several biopsies will be taken at the same time. The sample is then sent to a laboratory to be looked at by a pathologist. Pathologists are doctors who are experts at diagnosing illnesses by looking at cells. Depending on the number of biopsies taken, your breast may be quite bruised and tender afterwards. This may take a couple of weeks to disappear completely. Fine needle aspiration (FNA) A thin needle is inserted through the skin of the breast into the lump or suspicious area. The needle is used to draw off some breast cells and fluid. This may be done during a breast ultrasound. The cells and fluid are then sent to the pathology laboratory. If the lump is a cyst, the needle can draw off the fluid and the lump may disappear. If the lump is solid, the cells will be examined to see whether they are benign (non-cancerous) or malignant (cancerous). A fine needle aspiration can be painful for a short time. You may have some bruising for a few days afterwards. There is no evidence that either a biopsy or FNA will cause any cancer that might be present to spread. Sometimes core biopsies or FNA will be done by just feeling the breast lump for guidance. The biopsy needle can also be guided using ultrasound or mammogram. If the needle is guided by mammogram, it is known as a stereotactic biopsy. You will be positioned on a mammography machine that has a special device attached. In most units the test is done while you are sitting down, but in a few you will lie on your front. The radiographer then takes a picture of your breast from two Questions about cancer? Ask Macmillan Page 3 of 9

4 angles to work out the exact position of the abnormal area and to guide the needle into the right place. Sometimes a thin wire will be inserted into the breast to mark the position of the abnormal area, and a breast surgeon will then do an operation to remove the area. This is known as a wire-guided biopsy. A machine called a mammatome and a needle may be used for taking a biopsy. This method takes biopsies from the breast using a technique known as vacuum-assisted biopsy. It takes more tissue than a standard needle biopsy, which makes it particularly helpful for diagnosing abnormal areas in the breast where no lump can be felt, or if a standard biopsy result is unclear. A needle is placed into the breast tissue and guided to the correct area with the help of ultrasound or x-ray imaging. When the needle is in position, a vacuum gently draws, cuts and collects some breast tissue into a small collecting chamber. If you have any questions about the above tests you can ask the nurse in the assessment clinic. You can also contact our cancer information specialists on You may be able to have the results of your tests on the same day or a few days later, but if you have a core biopsy you may have to wait for your results for up to 14 days. This waiting can be a very anxious time, we can provide information on specialist support organisations. Possible results You will be given the results of your tests by a doctor at the assessment clinic. No problem seen The tests may find that there is no problem with the breast tissue. This means that the first mammogram showed evidence of a potential abnormal area in the breast, but further tests didn t find a problem. In this situation, the first mammogram is said to have had a false-positive result. You won t need to have any further tests or treatment and can go back to the screening unit for a routine mammogram in three years time. Many false-positive results are due to tiny deposits of calcium in the milk ducts, known as microcalcification. Page 4 of 9 Questions about cancer? Ask Macmillan

5 Microcalcification occurs in many women over the age of 50. It may occur when cancer is present, but in most women it just happens without there being a breast cancer or any other breast problem. We can send you information about breast calcification. Benign condition (not cancer) Most women will be told that they don t have cancer but have a benign (non-cancerous) condition. Many benign conditions of the breast can be seen on a mammogram. If you have a benign condition, you may be referred to a hospital breast care specialist for advice and for any necessary monitoring or treatment. Unsure diagnosis This happens very rarely. It means that no definite diagnosis can be made after assessment. In this situation a biopsy (see page 3) may be recommended or you may be invited for early recall, which means that you will have another invitation for a mammogram in 12 months. Breast cancer Only about 7 in every 1,000 women who have breast screening will be diagnosed with breast cancer. If your tests show that you have breast cancer, you will be referred to a consultant surgeon or a cancer specialist (a medical oncologist) at a cancer treatment hospital. You may have a range of emotions including shock, anxiety and fear. You will be able to talk to a breast care nurse who can help to support you and your family. We can send you a booklet, The emotional effects of cancer, which discusses the feelings that you may have. It gives advice on how to deal with your emotions and has details of sources of support. Treatment The consultant surgeon or medical oncologist will be able to discuss the treatment with you. Sometimes you may be offered a choice of treatments, and it s important to consider the benefits, risks and disadvantages of each carefully before deciding which treatment is best for you. You can discuss your treatment with the breast care nurse. Our cancer support specialists can also give you information about the different treatment options. Treatment for breast cancer usually involves some type of surgery: a lumpectomy, where just the lump and a small amount of surrounding Questions about cancer? Ask Macmillan Page 5 of 9

6 DCIS tissue is removed, or a mastectomy, where the whole breast is removed. Surgery is likely to be followed by radiotherapy, chemotherapy, hormonal therapy (such as tamoxifen or an aromatase inhibitor) or a biological therapy (such as Herceptin ). Sometimes a combination of these treatments is given. The treatment may take a few months. For women who attend breast screening the cancer is likely to be found early, when the chance of being cured is high. More than two-thirds of the cancers found during breast screening are small enough to be removed with lumpectomy rather than needing a mastectomy. Our booklet, Understanding breast cancer, gives information about breast cancer, its treatment and coping with cancer. Your tests may show a condition known as DCIS (ductal carcinoma in situ). One in every thousand women who attend a breast screening is diagnosed with DCIS. This is when the breast cancer cells are completely contained within the milk (breast) ducts and have not spread into the surrounding breast tissue. DCIS may also be referred to as non-invasive or intraductal cancer. Most women with DCIS have no signs or symptoms so it s mostly found through breast screening. DCIS usually shows up on a mammogram as an area where calcium has been deposited in the milk ducts (microcalcification). A small number of women with DCIS may have symptoms such as a breast lump or discharge from the nipple. If DCIS is left untreated it may, over a period of years, begin to spread into (invade) the breast tissue surrounding the milk ducts. It is then known as invasive breast cancer. Some areas of DCIS will never develop into invasive breast cancer even if no treatment is given. However, treatment is usually given for DCIS because it s not currently possible to tell which areas of DCIS will definitely develop into an invasive cancer. Treatment Treatment almost always cures DCIS. If you have DCIS you will be referred to a breast surgeon or cancer specialist (oncologist). It s important to discuss the benefits and possible side Page 6 of 9 Questions about cancer? Ask Macmillan

7 effects of any treatment in your particular case. The main treatment for DCIS is surgery. The surgeon removes all of the DCIS along with an area (margin) of normal looking tissue surrounding it. This is known as a wide local excision. Some women are given radiotherapy after a wide local excision. Removing the whole breast (mastectomy) is usually only advised if DCIS is large or affects more than one area of the breast. Breast reconstruction (making a new breast shape) can be done at the same time or later. Our booklet, Understanding DCIS, gives detailed information about this condition. A long-term study, called the Sloane Project, is being carried out to improve the care and treatment for women with DCIS found during the breast screening programme. The study, which is supported by the NHS Breast Screening Programme, aims to get good quality information about DCIS and to find out the best treatment for this condition. Breast awareness All women should be aware of how their breasts normally feel and look so that they can detect any changes, even if they are having regular breast screening. Breast awareness is part of general body awareness. It s a process of getting to know your breasts and becoming familiar with their appearance. Learning how your breasts look and feel at different times will help you to know what s normal for you. You can become familiar with your breast tissue by looking at and feeling your breasts you can do this in any way that s best for you (for example, in the bath or shower with a soapy hand, or when you re getting dressed). If you aren t sure what to look for, or if examining your breasts makes you anxious, you can ask your practice nurse or GP to show you. You can also go to a well-woman clinic to learn how to check your breasts. Your GP or practice nurse can give you details of your nearest clinic. The normal breast There is no such thing as a standard breast. What is normal for one woman may not be for another. Throughout your life your breasts will change. Below are some descriptions of a normal breast at different stages of your life. Questions about cancer? Ask Macmillan Page 7 of 9

8 Before the menopause Normal breasts feel different at different times of the month. The milk-producing tissue in the breast becomes active in the days before a period starts. In some women, the breasts at this time feel tender and lumpy, especially near the armpits. After the menopause Activity in the milk-producing tissue stops. Breasts normally feel soft, less firm and not lumpy. After a hysterectomy The breasts usually show the same monthly differences until the time when your periods would have stopped, unless your ovaries have also been removed.if your ovaries are removed before your natural menopause, you will have an early menopause and your breasts will change. Changes to look for Appearance Any change in the outline or shape of the breast, especially caused by arm movements or lifting the breasts. Also any puckering or dimpling of the skin. Feelings Discomfort or pain in one breast that is different to what is normal for you. Lumps Any new lumps, thickening or lumpy areas in one breast or armpit, that seem to be different from the same part of the other breast and armpit, and do not disappear after your monthly period. Nipple changes Look out for the following changes to your nipples: nipple discharge that is new for you and not milky bleeding or moist, reddish areas that don t heal easily any changes in nipple position if the nipple is pulled in or pointing differently a rash on or around the nipple. If you are aware of any change in your breast from what is normal for you, tell your doctor as soon as possible. If a cancer is present, the sooner it is reported, the simpler and more effective the treatment is likely to be. Remember, you re not wasting anyone s time. There are many reasons why your breasts may change. Most of them are harmless, but all of them need to be checked by a doctor, as there is a small chance that they could be the first sign of cancer. Page 8 of 9 Questions about cancer? Ask Macmillan

9 More information and support If you have any questions about cancer, ask Macmillan. If you need support, ask Macmillan. Or if you just want someone to talk to, ask Macmillan. Our cancer support specialists are here for everyone living with cancer, whatever you need. Call free on , Monday Friday, 9am 8pm We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN JANUARY 2011 Questions about cancer? Ask Macmillan Page 9 of 9

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