Further Evaluation Of Breast Cancer – What Comes After Mammography?

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If something suspicious is found in a routine mammogram the doctor will probably carry out a physical exam and use other methods to determine whether Breast Cancer is present.

Symptoms and any health problems will be asked about.

The doctor will especially inquire about risk factors such as

  • Age
  • Race
  • Family history
  • Personal history
  • Health history
  • Age of menarche and Menopause

Lifestyle and Breast Cancer

The rate of new cases was 24% higher in smokers than in nonsmokers and 13% higher in former smokers than in nonsmokers.

It must be understood that certain lifestyle habits increase the likelihood of getting breast cancer. These are smoking, being overweight or obese, taking hormones, drinking alcohol, having late pregnancies, not breast feeding etc. Other risk factors include being older in age, having had an early menarche (before the age of 12 years) or a late menopause (after 55), having had radiation therapy, having a relative who has had the disease, inheriting the genes for the disease, having dense breasts etc.

Physical Exam

The breasts will be thoroughly examined for any lumps or to check for any suspicious areas. If a lump is found it will be palpated for texture, size, and relationship to the skin and chest muscles. Any changes in the nipples or the skin of the breasts will be noted.

The lymph nodes in the armpits and above the collarbones may be palpated for because enlargement or firmness of these lymph nodes might indicate spread of breast cancer. The doctor will also do a complete physical exam to evaluate general health and whether there is any evidence of cancer that may have spread.

If breast symptoms and/or the results of the physical exam suggest breast cancer might be present, more tests will probably be done. These might include another mammogram, other imaging tests, lab tests of nipple discharge, or biopsies of suspicious areas.

Ultra Sound Examination

Ultrasound, also known as sonography, is another imaging test. It uses sound waves instead of X-rays for imaging. An ultrasound is not as sensitive a test as a mammogram. Moreover, it is very time consuming to screen both breasts so it is only used as secondary tool if a mammography shows any changes. For instance, it can help tell the difference between a solid lump and fluid-filled benign cysts.

MRI for Breast Cancer

Magnetic resonance imaging or MRIs use radio waves and strong magnets instead of x-rays. The MRI gives a very detailed and clear picture of the breast tissues. To look for cancer a contrast liquid called gadolinium is injected into a vein before or during the scan to show details better.


A ductogram, also called a galactogram, is sometimes used to help find the cause of any worrisome nipple discharge. In this test, a very thin metal tube is put into the opening of a duct in the nipple that the discharge is coming from. A small amount of contrast material is put in. It fills the duct and shows up on the on the xray. It can thus show if there is a mass inside the duct. If there is any discharge from the nipple, some of the fluid may be collected and checked in the lab for signs of infection or cancer cells.


A biopsy is done when mammograms, the physical and other exams strongly suggest breast cancer. A biopsy is the only way to know for sure if it’s cancer. For a biopsy, a sample (tiny piece) of the suspicious area is taken out and tested in the lab. The sample is called a biopsy specimen.

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