For many women, a breast cancer diagnostic process begins with uncertainty. To help make the breast cancer journey feel a little less intimidating, Breast Specialist Dr. Jamie Patterson explains what you can expect – from recognizing symptoms and seeking medical attention to understanding mammograms, ultrasounds, biopsies, pathology results, and treatment planning. Her goal is to provide clear, reliable information that helps replace uncertainty with knowledge and prepares you for what comes next. 

Common Signs of Breast Cancer 

The most common and well-known symptom of breast cancer is a new lump or mass. Other possible signs of breast cancer include: 

• Breast or nipple pain 

• Nipple discharge other than breast milk 

• Nipple retraction (turning inward) 

• Persistent redness, scaliness, or thickening of the nipple or breast skin 

• Skin irritation or dimpling 

• Swelling of all or part of a breast (even if no distinct lump is felt) 

• A change in skin color 

Remember that everyone is unique, so symptoms may appear differently for each person. Some people also don’t show any signs at all. If you notice any of these symptoms and they last for more than a few days, call your OBGYN. 

Mammograms 

Mammograms are essentially an x-ray of your breasts used to find early signs of cancer. There are two main kinds: 

• Screening mammogram: This is a routine exam for people who don’t have any symptoms to look for early signs of breast cancer before symptoms develop. It involves standard X-ray images of each breast and is performed annually. 

• Diagnostic mammogram: This is done when you have symptoms or if the screening mammogram revealed something unusual; it includes more targeted images of the area of concern. The radiologist usually reviews the images while you’re there to decide if you should get more views or an ultrasound. 

How Breast Density Can Affect Mammogram Results 

About 40 to 50% of all women have dense breasts, which is an important factor to consider when it comes to looking at mammograms. On a mammogram image, fatty tissue appears dark while dense breast tissue appears white. Unfortunately, abnormalities (masses, areas of asymmetry, and calcium deposits) also appear white. When dense breast tissue and potential tumors look similar on the image, it can create a “masking effect” that makes it harder for radiologists to spot early-stage cancer because it can hide in plain sight.  

Because of this, women with dense breasts are more likely to be called back for additional imaging after their mammogram. This can be unsettling, but a callback doesn’t necessarily mean something is wrong; the radiologist might simply need a closer look to ensure they get the clearest picture possible and can confidently evaluate your breast health.  

When an Ultrasound is Needed 

Sometimes after a diagnostic mammogram, your provider may recommend a breast ultrasound for a closer look. Ultrasounds can help determine whether a lump is a fluid-filled cyst, which is usually benign, or a solid mass that may need further evaluation. 

Biopsy 

After a radiologist reviews the images, they may recommend a biopsy if they see an area that needs to be examined more closely. A biopsy removes a small sample of tissue so it can be tested to determine whether the area is benign or cancerous.  

There are three main types of biopsies for breast cancer: 

• Stereotactic (mammogram-guided) biopsy: This is used when the abnormal area can only be seen on a mammogram. During the procedure, your breast is positioned in the mammogram machine and a small tissue sample is collected with a needle.  

• Ultrasound-guided biopsy: This is used when the abnormal area can be seen on an ultrasound. It’s usually a more comfortable option since it doesn’t require breast compression like a mammogram does. 

• MRI-guided biopsy: This is used when the area of concern can only be seen on an MRI. The procedure is performed inside an MRI scanner and requires an IV and contrast dye to help guide the biopsy. 

What to Expect 

It’s completely normal to feel nervous before a biopsy, but knowing what to expect can help. Most biopsy appointments take about an hour. The procedure begins with imaging (either a mammogram, ultrasound, or MRI) to precisely locate and measure the area being biopsied. 

Next, they numb the biopsy site with a local anesthetic called lidocaine, similar to what you might receive at the dentist. You may feel a brief burning or stinging sensation during the injection, but that’s typically the most uncomfortable part.  

Once the area is numb, you may notice some pressure or movement during the biopsy, but you shouldn’t feel sharp pain. After collecting several small tissue samples, they will then place a tiny titanium marker clip smaller than a grain of rice at the biopsy site. The clip stays safely in the breast and serves as a landmark for future imaging and monitoring. If cancer is found, it helps identify the exact location for surgery or other treatment. 

Diagnosis and Treatment 

The lab usually takes about a week to analyze the samples and give your provider a full pathology report, which explains whether the abnormality is benign or cancerous. Doctors use this information to make a final diagnosis and determine what stage of breast cancer you’re in. The report also explains how the cancer behaves biologically so that your doctor can determine the best treatment plan moving forward.  

Once you receive your diagnosis, your doctor will discuss whether you need any additional diagnostic imaging before you begin treatment. Although this might feel frustrating, taking the time to gather all the necessary information and carefully consider your options helps ensure you receive the treatment or surgery that’s best for you. National guidelines recommend starting treatment within 60 days of diagnosis, but Woman’s aims to start much sooner – hopefully within about a month.  

One Step at a Time 

Waiting for answers can be one of the most difficult parts of the breast cancer journey, but understanding what to expect can help ease some of the uncertainty. Whether you’ve noticed a change in your breast or received an abnormal mammogram result, remember that most breast changes are not cancer – but every concern deserves prompt evaluation. If a breast cancer diagnosis is confirmed, know that there’s time to gather the information you need, consider your treatment options, and work with your care team to choose the approach that’s right for you.