Tests to Help Diagnose Breast Cancer in Men

Medical history and physical exam

If there is a chance you have breast cancer, your doctor will want to get a complete personal and family medical history. This may give some clues about the cause of any symptoms you are having and if you might be at increased risk for breast cancer.

A complete breast exam will be done to find any lumps or suspicious areas and to feel their texture, size, and relationship to the skin and muscle. The doctor may also examine the rest of your body to look for any evidence of possible spread, such as enlarged lymph nodes (especially under the arm).

Imaging tests for breast cancer in men

If you have signs or symptoms that could mean breast cancer or another breast disease, your doctor might recommend one or more or the following imaging tests.

Diagnostic mammogram

A mammogram is a low dose x-ray exam of the breast that allows doctors called radiologists to look for changes in breast tissue. It is called a diagnostic mammogram when it is done because problems are present.

A mammogram uses a machine designed to look only at breast tissue. The breast is pressed between 2 plates to flatten and spread the tissue. The compression only lasts a few seconds and may be uncomfortable briefly, but it is necessary to get a better picture. In some cases, special images known as cone or spot views with magnification are taken to make a small area of abnormal breast tissue easier to evaluate.

The results of this test might suggest that a biopsy is needed to tell if the abnormal area is cancer. Mammography is often more accurate in men than women, since men do not have dense breasts or other common breast changes that might interfere with the test.

Breast ultrasound

Breast ultrasound is often used to examine some types of breast changes.

Breast ultrasound uses sound waves to make a computer picture of the inside of the breast. A gel is put on the skin of the breast, and a wand-like instrument called a transducer is moved over the skin. The transducer sends out sound waves and picks up the echoes as they bounce off body tissues. The echoes are made into a picture on a computer screen. You might feel some pressure as the transducer is moved across the breast, but it should not be painful.

This test does not expose you to radiation.

Breast ultrasound is often used to look at breast changes that are found during a mammogram or physical exam. It is useful because it can often tell the difference between fluid-filled cysts (which are unlikely to be cancer) and solid masses (which might need further testing to be sure they're not cancer).

In someone with a breast tumor, ultrasound can also be used to check if the lymph nodes under the arm are enlarged. If they are, ultrasound can be used to guide a needle to take a sample (a biopsy) to look for cancer cells there and in the breast tissue.

Breast Biopsy

When other tests show that you might have breast cancer, you will probably need to have a biopsy. Needing a breast biopsy doesn’t necessarily mean you have cancer. Most biopsy results are not cancer, but a biopsy is the only way to find out. During a biopsy, a doctor will remove cells from the suspicious area so they can be looked at in the lab to see if cancer cells are present. It typically takes at least a few days for you to find out the results.

If your doctor thinks you don’t need a biopsy, but you still feel there’s something wrong with your breast, follow your instincts. Don’t be afraid to talk to your doctor about this or go to another doctor for a second opinion. A biopsy is the only sure way to diagnose breast cancer.

There are different types of breast biopsies. The type you have depends on your situation.

Fine needle aspiration biopsy (FNA): This type of biopsy is often used to look for cancer spread in the nearby lymph nodes. The doctor uses a very thin, hollow needle attached to a syringe to withdraw (aspirate) a small amount of tissue or fluid from a suspicious area. A local anesthetic (numbing medicine) may or may not be used. The biopsy sample is then checked to see if there are cancer cells in it.

If the area to be biopsied can be felt, the needle can be guided into it while the doctor is feeling it. If the lump can't be felt easily, the doctor might watch the needle on an ultrasound screen as it moves into the area. This is called an ultrasound-guided biopsy.

An FNA biopsy is the easiest type of biopsy to have, but it can sometimes miss a cancer if the needle does not go into the cancer cells.

If the results of the FNA biopsy do not give a clear diagnosis, or your doctor still has concerns, you might need to have a second biopsy or a different type of biopsy.

Core needle biopsy (CNB): This is the most common type of biopsy used to make a breast cancer diagnosis. The doctor uses a wide, hollow needle to take out pieces of breast tissue from a suspicious area.  The needle used in this technique is larger than that used for FNA and allows the doctor to remove larger cylinders (cores) of tissue. Several cylinders are often removed. The biopsy is done with local numbing medicine and with the doctor either feeling the abnormal area or using an imaging test (like ultrasound or MRI) to find the spot to biopsy.  

In addition to the standard CNB, there are two other types of CNBs: 

• Stereotactic core needle biopsy
• Vacuum-assisted core biopsy

If the results of the CNB do not give a clear diagnosis, or your doctor still has concerns, you might need to have a second biopsy or a different type of biopsy.

Surgical (open) biopsy: Most breast cancer can be diagnosed with a needle biopsy. Rarely, surgery is needed to remove all or part of the lump for testing. Most often, the surgeon removes the entire mass or abnormal area, as well as a surrounding margin of normal-appearing breast tissue.

There are 2 types of surgical biopsies:

• An incisional biopsy removes only part of the suspicious area, enough to make a diagnosis.
• An excisional biopsy removes the entire tumor or abnormal area, with or without trying to take out an edge of normal breast tissue (depending on the reason for the biopsy).

Lymph node biopsy: The doctor may also need to biopsy the lymph nodes under the arm to check them for cancer spread. This might be done at the same time as biopsy of the breast tumor, or during surgery to remove the breast tumor. This is done by needle biopsy, or with a sentinel lymph node biopsy and/or an axillary lymph node dissection.