Dedicated to the care of breast cancer and all breast conditions
Dr Sarah Rayne is no longer practising in
Johannesburg and this practice is closed.

These pages are for information only,
and current only until 2018
I’ve just been diagnosed with breast cancer- help!
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I’ve noticed a lump in my breast
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Investigating the breast using imaging (Radiology)  
It is difficult (even for doctors) to feel the difference between a lump that is normal and breast cancer, so it is important when you have a breast problem to get a doctor who knows about the breast to examine you and organise some extra tests. Radiology uses a number of technologies see inside the breast and make double certain that everything is OK, or to take a sample of breast tissue away.
MRI (Magnetic Resonance Imaging)
Other tests
There are lots of different ways to assess the breast, some proven and some not proven. Choosing the best option often depends on your age, risk factors, problem and even the type of breast tissue you have.
This is the best known way of looking at the breast. A low-dose X-ray is taken of the breast whilst it is flattened to make sure as much as possible is seen. Normally pictures are taken from top-to-bottom (craniocaudally-CC) and side-to-side (medio-lateral-oblique-MLO) but extra views or magnified views can help get the right diagnosis. The pictures are then looked at by a radiologist specialised in reading mammograms, and they look for darker or lighter than normal areas and any differences between the two sides.

Mammograms tend not to be so useful for younger women, and routinely should not be carried out on women under 35 years unless there is a good reason. Be sure you ask and understand the reason why you are having a mammogram if you are young.

No test can offer 100% accuracy and in mammography there is a 10-20% false-negative rate. That means that some worrying areas or cancers will not show up on the mammogram and be missed. If you have a normal mammogram and still notice a problem, get further advice about how to proceed from your doctor.

If your breasts are dense or you have had previous surgery, reading the mammogram can be harder. Always take along any old mammograms you have- because it helps determine if any differences are new or old, and so keep copies of your mammogram yourself- ask for films or a disk before you leave after your appointment.
Ultrasound is a great addition to mammogram. Routinely in South Africa women get both done at the same time. Ultrasounds are really good at complementing a mammogram, or seeing problems in younger women. They can also see fluid better, and can be used to guide a needle to the right place if you need a biopsy.

The accuracy of ultrasound depends on the experience of the person carrying it out, which is why it is a good idea to make sure your test is done by a radiologist specialised in looking at the breast.
MRI (Magnetic Resonance Imaging)
MRI uses the effect of magnetic fields on your body’s water to generate a picture. It doesn’t just show the structure of the breast, but how it is behaving, including the behaviour of any lumps or abnormalities. It is not a comfortable test to go through, and it can be expensive, so normally it is used when additional information is needed after mammogram or ultrasound. It is also a great test for young women at very high risk of cancer.
Other (less common) options
Tomosynthesis is a new 3D way of looking at the breast that can be used in conjunction with a mammogram at present. Because it takes more pictures in addition to a mammogram, there is a slightly higher dose of radiation but with that comes a closer look at the breast tissue, and still within recommended guidelines.

PET scan (Positron Emission Tomography) is a method of picking up unusually hardworking metabolically-active tissue within the body by giving a tracer injection and then taking pictures of the whole body. It is good for picking up when cancer has spread around the body, and monitoring the response to whole body treatments.

Thermography uses heat-signals rather than radiation to look at the breast and is based on the principle that cancerous tissue will produce more heat. Unfortunately not all cancers do, and non-cancerous problems can also produce heat. At present there is no safe evidence to show it can do the same job as mammography or that it is safe to replace mammography. Therefore it is not recommended as a stand-alone investigation for breast problems.

There are many other methods of breast investigation that are available, often recommended by people who do not believe in science or marketed to people who would like to avoid radiation. Unfortunately none of them been proven to find (or rule-out) cancer accurately. Some tests can cost far far more than the simple tests outlined above, and leave you with a false sense of reassurance or unnecessary concern.