Step One: Make These Phone Calls
Time Frame: That Day
* Call #1: Your ob-gyn: This doctor knows your history and breasts, and can help you through this process. Tell the receptionist that you found a lump or got a call that your mammogram is abnormal, not just that you need an appointment. The doctor may ask you to come in or may refer you right away for imaging studies or just send you to a breast specialist.
* Call #2: A breast surgeon: Ask your doctor’s office to call the specialist directly, which may get you in faster. You may be asked to have additional mammographic views or a breast ultrasound before your visit. Even if the lump proves malignant, though, there’s usually risk if you can’t be seen for a few weeks. (But if you have sudden skin changes associated with a mass, tell your doctor since there is a rare but aggressive form of cancer called inflammatory breast cancer that requires urgent attention.)
* Call #3: Your insurer: Especially if you’re in an HMO, your insurance company may require that you see a gynecologist or an internist before the specialist. If you don’t get a referral at the beginning, you might be denied coverage for needed treatment later. You need to know what your plan will cover and if there are restrictions about where you can receive care.
Step Two: Prepare for Your Appointment
Time Frame: Days to a Few Weeks
* Write down details about the lump: how hard it is, whether it is painful, whether it moves when you touch it, its size (compared with a pea’s, for instance), and whether the size has changed. Plus: where you were in your menstrual cycle or sequential hormone therapy when you found it.
* List the prescription medications, over-the-counter drugs, and all supplements you take regularly. (A variety of medications can cause lumpiness.)
* Pick up your past two years’ worth of mammograms if they were taken at a different center. Be certain to have the actual films and the written reports for both mammograms and an ultrasound if you have had one.
* Outline a brief medical history, especially previous breast lumps or abnormal mammogram findings. It is important to note any previous breast biopsies and the results from them, specifically atypical lesions. Note any family history of breast or ovarian cancer in both your father’s and mother’s families.
Step Three: Get Evaluated
Doctors diagnose breast cancer by the "triple test": physical exam, imaging, and biopsy. If you’re at a comprehensive center that does it all, plan to be there much of the day.
The breast surgeon will manually examine all breast tissue and lymph nodes. You will be examined sitting up and lying down. If the doctor can’t find the lump, move into the same position you were when you felt it.
Imaging: Mammogram and Breast Ultrasound
You may have one or more types of imaging (ultrasound, mammogram or, less frequently, MRI). Which one you have first depends mostly on your doctor’s suspicions about the type of lump, and may also depend upon when your last mammogram was performed.
Mammography is the only breast cancer screening tool for the general population, though high-risk women are sometimes screened with MRIs as well. Digital mammography, which allows for better imaging in women with dense breasts, has begun to replace the familiar “film screen” mammography for screening.
A mammogram done for diagnostic purposes provides views that magnify or compress specific regions of the breast. This will likely be ordered if there is a mass or if your screening mammogram shows microcalcifications (tiny calcium deposits) and/or dense tissue.