The Breast Cancer Diagnosis Journey: Dissected
A breast cancer diagnosis is a poignant and vulnerable moment in the life of any woman. Have you ever wondered what happens behind the scenes before a breast cancer diagnosis is confirmed? The journey is not just a series of tests and appointments, it is a path marked by expert medical care and compassionate support.
In this blog, we’ll take you step-by-step through the diagnostic process, from a patient presents symptoms until they receive a diagnosis, uncovering the often-overlooked network of clinicians and lab staff which makes a single diagnosis possible.
Typically, a diagnosis journey begins during routine screening processes or when a patient experiences symptoms. For example, a lady may discover a lump in her breast which concerns her. In this case, she is likely to schedule an appointment with her GP as a first point of contact.
During the appointment with her GP, she is examined and asked about her symptoms, typically questions around how long she has been experiencing symptoms, and if she has noticed anything else which feels unusual for her.
If the GP is concerned about the lump, they refer the lady onwards to have a mammogram in a mammography clinic.
A radiographer will walk the lady throughout the mammography process, from having the procedure done to some pastoral support at a sensitive time. A radiologist reads the results, and if the mammogram findings are unclear or the lump appears benign, additional imaging such as ultrasound or MRI may be performed first. If they notice something which indicates malignancy to them, such as a tumour within the breast, they will proceed forward with a breast core biopsy.
A breast core biopsy is performed. The needle is inserted into the centre of the area of concern, and tissue is removed to assess if cells are potentially malignant. The radiographer images the core biopsy sample in an x-ray machine and looks for microcalcifications: bright areas in the tissue which are indicators of malignant cells. If the radiographer finds microcalcifications in the lady’s sample, she is referred onwards for surgery, to have the entire tumour removed.
Once it is determined that the tumour is of a reasonable size to be excised without the need for neoadjuvant therapy, the lady receives a date for surgery and is brought in to have the tumour removed. In the case of a lumpectomy, a surgeon excises the tumour along with some margin tissue, in the hope that no cancerous cells will remain and the patient will not have to be re-excised for further surgery.
While the lady is recovering from surgery, the journey towards formal diagnosis continues in the background.
The tumour excised in surgery travels to pathology, where it goes through multiple stages of examination. Firstly, the whole sample is dissected, examined and photographed, where a pathologist or biomedical scientist highlights any features or areas of interest, which ultimately feeds into the lady’s pathology report.
Once dissected, it is then treated, fixed in formalin, and embedded in paraffin wax. The wax block is then sliced into ultra-thin slices and placed onto glass slides. The glass slides are then dyed, scanned and digitised, where a pathologist looks at them digitally. The pathologist examines the images, which based on the features and areas of interest they see, forms the basis for a formal diagnosis. A report is generated which combines the patient’s record (core biopsy images, surgical images, gross images, and digitised slides), and the pathologist gives a diagnosis.
The report is then sent back to the patient’s GP.
The oncology team then discuss with the patient her formal diagnosis, and next steps towards her recovery.
Throughout the breast cancer journey, we can see how many medical professionals are involved in the culmination of a single diagnosis. Not only in the testing of patient samples, but in the guidance, care and support of each patient throughout a particularly vulnerable moment in their lives, when they need support the most.
Many of these medical professionals carry out their daily work with little acknowledgement of the vital role they play in helping each patient to get their diagnosis and work towards recovery.
Thank you to all of these professionals, from GPs, to radiographers, to biomedical scientists and pathologists, surgeons, nurses and more: thank you for the incredible work you do and for the life changing impact you have in the lives of patients.