Step 2: Get Ready for a Biopsy
Reality check: Just because your doctor wants a tissue sample doesn't mean you have cancer. As many as 77% of the 1 million breast biopsies performed each year in the U.S. turn out to be benign, according to a recent study. But if the images of your lump leave doubts about a diagnosis, a biopsy is the only way to be certain. Depending on how big your lump is, where it's located, and how suspicious it seems, you'll need at least one of these three procedures:
"It didn't hurt at all."
- Fine needle aspiration. This quick test, which can be performed in a doctor's office, is often done if your mass looks like a fluid-filled cyst. A superfine needle is inserted into the lump. If it's clearly a cyst, the fluid removed is non-bloody and easily drained. When there's any doubt, the removed tissues or cells are checked for cancer. If there's a pathologist on the premises to analyze the sample, you can have an answer in as little as 10 minutes (otherwise, you'll have to wait overnight). Expect to feel a prick and some pressure while the needle is inserted and the growth is located.
- Core needle biopsy. If the lump looks solid, you'll go straight to this test, which takes up to 45 minutes and is done in a hospital on an outpatient basis. First, your skin is numbed with an injection, then a surgeon inserts a special-tipped, hollow-core needle into your lump and surrounding area at least three times to remove small cylinders of tissue. In some cases the surgeon uses ultrasound to guide the needle, in others X-rays are used—either way, you'll have some temporary bruising and soreness and possibly a little permanent scarring at the needle entry points.
- Excisional biopsy. This is just what it sounds like: a cut in the skin in order to remove the entire lump and surrounding tissue so they can be looked at under a microscope. It's usually same-day surgery done with local anesthesia, but most experts view it as the last resort since it causes soreness and scarring, and doesn't always spare you from another surgery if cancer is found. "It's warranted only in rare cases, such as when a core biopsy is inconclusive," says Nora Hansen, M.D., director of the Lynn Sage Comprehensive Breast Center at Northwestern Memorial Hospital.
Forty-four-year-old Belinda Smith had an X-ray-guided core needle biopsy last year. The mother of two, who lives in Orlando, lay facedown on a table with her breast placed in an opening; the table then rose so the radiologist could work underneath her. "It was like a mechanic working on a car," she says. A mammography unit compressed her breast while computer images helped pinpoint the area to be biopsied. "It was so cutting edge," says Belinda, who admits the process left her "worn out and achy the next day." Her biopsy revealed a small, early-stage cancer that was treated with a breast-sparing lumpectomy and a brief course of radiation.