Triple assessment of breast cancer

Diagnosis: Triple Assessment If you have been referred to hospital with any breast problems, for example a lump or a change in the appearance of your breast, testing for breast cancer should include three tests – triple assessment – based on: • Clinical (physical) examination • Breast imaging (mammogram or ultrasound) • Core biopsy and/or fine needle aspiration (FNA) Biopsy might not be used if the symptom being investigated is a change in the appearance of the breast without a lump. The best available, but not infallible, methodology for the diagnosis or exclusion of cancer is made by using these tests. • In the clinical examination, your specialist doctor will ask you questions and then examine you. • The imaging will be a Mammogram– this is an X-ray carried out on the breast which is produced by exposure to a controlled source of X-rays and recorded on special photographic film or in digital form on computer); or an Ultrasound– this is a test that uses sound waves to build a picture of the inside of the body. You lie on your back while a device like a microphone is passed over your breast. The sound waves then make pictures of your breast on a computer screen. • For the tissue biopsy test, a small needle is passed through the skin and into the breast lump, to get a sample of cells. The sample is then sent to the laboratory to be looked at under a microscope. For this, you have a local anaesthetic and a small cut is made in the skin. A needle is used to take out a small ...

Triple-negative breast cancer (TNBC) accounts for about 10-15% of all breast cancers. The term triple-negative breast cancer refers to the fact that the cancer cells don’t have BRCA1 mutation. TNBC differs from other types of invasive breast cancer in that it tends to growand spread faster, has fewer treatment options, and tends to havea worse prognosis (outlook). Signs and symptoms of triple-negativebreast cancer Triple-negative breast cancer can have the same How is triple-negative breast cancer diagnosed? Once a breast cancer diagnosis has been made using Survival rates for triple-negative breast cancer TNBC tends to grow quickly, is more likely to have spread at the time it’s found, and is more likely to come back after treatment than other types of breast cancer. Because of this, the survival rates for TNBC are generally not quite as high as they are for other types of breast cancer. Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. They can’t tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful. Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case. These statistics can be confusing an...

Palable breast masses are common and usually benign, but efficient evaluation and prompt diagnosis are necessary to rule out malignancy. A thorough clinical breast examination, imaging, and tissue sampling are needed for a definitive diagnosis. Fine-needle aspiration is fast, inexpensive, and accurate, and it can differentiate solid and cystic masses. However, physicians must have adequate training to perform this procedure. Mammography screens for occult malignancy in the same and contralateral breast and can detect malignant lesions in older women; it is less sensitive in women younger than 40 years. Ultrasonography can detect cystic masses, which are common, and may be used to guide biopsy techniques. Tissue specimens obtained with core-needle biopsy allow histologic diagnosis, hormone-receptor testing, and differentiation between in situ and invasive disease. Core-needle biopsy is more invasive than fine-needle aspiration, requires more training and experience, and frequently requires imaging guidance. After the clinical breast examination is performed, the evaluation depends largely on the patient’s age and examination characteristics, and the physician’s experience in performing fine-needle aspiration. Key clinical recommendation Label References Ultrasonography-guided CNB should be considered to diagnose malignancy in women with palpable breast lesions. C In young women with dense breast tissue, ultrasonography should be used rather than mammography to detect breast...

The patient An 81 year old woman was referred to a multidisciplinary breast clinic with a lump in her right breast. Such patients undergo “triple” assessment—clinical examination, imaging, and, if necessary, needle biopsy. On clinical examination she had a mass in the upper outer quadrant, which was suspected to be an underlying carcinoma. Mammography Mammography has been evaluated more extensively than any other imaging technique and remains a mainstay of the diagnosis of breast cancer. Reported sensitivity in detecting palpable breast cancer is 80-90%, 1 but it is lower in patients with dense breast parenchyma. A normal mammogram can be seen in the presence of a palpable breast cancer, so national guidance recommends that all breast units should provide triple assessment clinics for symptomatic women rather than an open access imaging service for general practitioners. 2