The next steps depend on the likelihood
that cancer is present, as judged by
the mammograms you have had so far.
If the abnormality is judged to be definitely
benign (no cancer), no further investigation
is needed. (You should, of
course, continue to have your usual
check-ups.)
Even if the abnormality cannot be diagnosed
with certainty as benign, it still
may be very unlikely to be cancer. In this
situation, usually nothing is recommended
except regular follow-up mammography
and physical examinations to
detect any suspicious change quickly.
These follow-up examinations usually
take place after 6, 12 and 24 months,
and annually for 2 to 3 years after that if
no changes are seen. If the abnormality
does turn out to be cancer, it will usually
show a change within the first year.
Rarely, it may take longer.
Although this sort of abnormality is
very unlikely to be cancer, there is still a
very small chance that it might be. If you
feel a strong need to know with certainty
at this point, a biopsy can be performed.
If the risk of cancer is judged to be intermediate
(a probability of cancer between
2% and 10%), a “needle biopsy” (either
fine-needle aspiration or core biopsy) is
usually recommended to remove a small
amount of tissue for microscopic examination.
Fine-needle aspiration removes
only a few cells. A core biopsy, using a
larger needle, can give a more reliable result
in some instances. Since the lump
can only be seen on the mammogram
but not felt, the doctor will use a mammogram
or ultrasound “picture” to help
locate the abnormality while doing the
needle biopsy.
Sometimes the risk of cancer is judged
to be high (a probability greater than
10%). In these instances, some centres
may recommend core biopsy to remove
some tissue for examination, and others
may recommend surgical removal of the
entire area of abnormal tissue for examination.
This is called a “surgical biopsy.”
Just before the operation, a mammogram
or ultrasound image will be used to
guide the placement of tiny wires in your
breast. These are needed to “mark” the
abnormal area for the surgeon (since no
lump can be felt). After removal, the tissue
is x-rayed to make sure it contains all
the abnormalities seen on the mammogram.
Often, if the abnormal tissue was
removed during the biopsy, no further
surgery is necessary.
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