9. Further assessment after the mammogram
9.1 Tomosynthesis for further assessment
Recommendations
After mammography screening, if you need further assessment, what test should be used?
Digital breast tomosynthesis (DBT) rather than mammography, as suggested by the ECIBC's Guidelines Development Group (GDG).
Who are these recommendations for?
- You do not have a high risk of developing breast cancer
- You had a mammogram or other screening test and the results were unclear
- You were recalled for further assessment following this unclear result
What would following these recommendations mean for you?
It might be important to speak with your healthcare professional about the unclear results of your mammogram or other screening test.
You may also wish to speak about:
- why unclear results in mammograms occur
- how DBT is performed
- your comfort during the tests
- the chances of an incorrect diagnosis or finding cancer
- what happens after
Additional considerations
When using DBT, more women are correctly diagnosed and fewer are told they have breast cancer when in reality they do not.
The GDG noted that the costs of DBT would be higher and that the availability of the equipment and specialist training varies between countries.
9.2 Obtaining a sample from a suspicious breast lesion
Recommendations
If you have a breast lesion that may be a sign of cancer, what procedure should you be offered to diagnose the lesion: needle core biopsy or fine needle aspiration cytology?
Needle core biopsy, as recommended by the ECIBC's Guidelines Development Group (GDG), rather than fine needle aspiration cytology.
Who are these recommendations for?
You had a mammogram or other screening test that showed a lesion.
You may have been told that the lesion may be a sign of cancer and you wish to have the lesion tested. So, a sample of tissue from your breast is needed to test for cancer.
The lesion could be one of the following:
- a mass in your breast
- calcium deposits in your breast
called calcifications or microcalcifications - an area of dense tissue only in one of your breasts
(also called asymmetric) - an abnormal structure of your breast tissue
What would following these recommendations mean for you?
It might be important to speak with your healthcare professional about the abnormal results of your mammogram or other screening test.
You may wish to speak with your healthcare professional about how the needle core biopsy is performed and how you feel about:
- your comfort during and after the procedure
- the chances of an incorrect diagnosis or finding cancer
- what happens after you have the results
- any concerns you have about whether a biopsy could cause cancer to grow faster or spread
Additional considerations
With needle core biopsy more women are correctly diagnosed and fewer are told they have breast cancer when in reality they do not.
With needle core biopsy it is also possible to identify the type of tumour and then study how the tumour is likely to behave.
Although the needle used for a needle core biopsy is larger than the one used with fine needle aspiration cytology, the chances of bleeding or pain are only slightly higher.
The GDG noted that the cost of providing needle core biopsy may be slightly greater than providing fine needle aspiration cytology. However, since there are more correct diagnoses with needle core biopsy, the test may not need to be repeated, and money would be saved.
Definitions
Biopsy: is a procedure that obtains a small amount of breast sample from a suspicious area to be tested for cancer.
Fine needle aspiration cytology (FNAC) uses a thin needle to aspirate the sample.
Needle core biopsy (NCB) uses a larger needle attached to an automated device or a suction device (vacuum-assisted needle core biopsy) to obtain breast tissue.
9.3 Type of guidance for needle core biopsy
Recommendations
If you have breast calcifications (calcium deposits or microcalcifications) that may be a sign of cancer, how should the needle core biopsy be performed to diagnose them?
The ECIBC's Guidelines Development Group (GDG) recommends that needle core biopsy or vacuum assisted needle core biopsy are stereotactic-guided rather than ultrasound-guided.
Who are these recommendations for?
- You had a mammogram or other screening test and the results were unclear
- You may have been told that you have calcium deposits in your breast which may or may not be a sign of cancer
- You wish to have the lesion tested and now a sample of tissue from your breast is needed to test for cancer
What would following these recommendations mean for you?
It might be important to speak with your healthcare professional about the unclear results of your mammogram or other screening tests.
You may wish to speak with your healthcare professional about how the stereotactic-guided needle core biopsy (NCB) or stereotactic-guided vacuum assisted needle core biopsy (VANCB) are performed and how you feel about:
- your comfort during and after
- the chances of an incorrect diagnosis or finding cancer
- what happens after you have the results
- any concerns you have about whether a biopsy could cause cancer to grow faster or spread
Additional considerations
With stereotactic-guidance more women are correctly diagnosed and fewer are told they have breast cancer when in reality they do not.
In addition, with stereotactic-guided NCB, the chances of sampling the relevant lesion associated with the calcification are higher.
The GDG noted that equipment for stereotactic-guided NCB may not be available everywhere. This means that women may need to be referred where it is available.
Definitions
Biopsy: is a procedure that obtains a small amount of breast sample from a suspicious area to be tested for cancer.
Needle core biopsy (NCB) uses a larger needle attached to an automated device or a suction device (vacuum-assisted needle core biopsy) to obtain breast tissue.
Needle core biopsy can be guided to its precise location by a mammogram machine connected to a computer (stereotactic-guidance) or by an ultrasound machine (ultrasound-guidance).