I’ve found a lump in my breast – What happens next? The breast diagnostic clinic

[Sally – Patient] I used to check every now and then check
myself every now and then and this particular day I found a lump. I wanted
to try and get it checked as quickly as
possible. [Louise – Radiologist] If you can come as early as you’re concerned don’t worry about it go and see your GP come to the clinic and
we want to try and diagnose any problem you have as quickly and as early as
possible. [Dawn – Doctor] We first start by just finding out what your concerns are why
you’re coming to see us today what symptoms you’ve got how long you’ve had
them any concerns that you have
specifically. [Sally – Patient] I went along to the
doctors and saw them and she was really good. She carried out an examination. [Dawn – Doctor] We would pretty much do an examination in these circumstances, we need to see the
breast as well and the area that’s concerning for you.
So we would ask you to strip from the waist above we have an examination couch
with a curtain that we provide privacy for you. We will look at both
breasts even if you’ve got a problem just with one so we can compare one side
to the other, we will examine and lay a hand on your breast
we may also examine your armpits and around the neck area as well. [Sally – patient] I seem to
remember laying down and then also sitting up and everything
so she was very thorough with her examination and then said that she would
refer me to the hospital – to get it checked. [Dawn – Doctor] So we’ve got a very clear
guidelines for us as G.P.s as to when we should be referring patients to the
breast clinic, so breast lumps are the commonist cause that we would refer to
a breast clinic for and generally over the age of 30 if you have a breast lump that
we cannot easily explain or we’re not sure we would refer you to the breast
clinic for further assessment. But often when we’ve examined you, we will know
whether we can explain that easily and we don’t have to refer you or whether
actually for completion and reassurance we may want to refer you on to the
breast clinic. The majority of patients however that do end up at a breast
clinic do not have breast cancer. [Kate – Patient contact centre] We know that we’ve got to see all patients that
are referred within the timeframe of 14 days we try our best to contact yourself
as quickly as possible and interact with the departments as fast as we can to get
these appointments booked in, to give yourself reassurance and try and get you
a date and time so then we can make you feel a little bit less anxious knowing
that that’s all booked for you. [Louise – radiologist] You should be thinking it’s a half a day visit so if it’s in the morning then you should be thinking you’ll be there all
morning and actually into the lunch hour similarly if it’s an afternoon clinic
expect to be there until at least five o’clock, it can be a long time. [Sally – patient] You
go and see a consultant they go through with you, you know the fact that
your doctor sent you over, they examined me then said that they were going to
send me for some tests. [Nick – Registrar] Breast examination and assessment is based on triple assessment and so it’s a combination of our assessment clinically
combined with radiology which could be an ultrasound or a mammogram or both and
also if needed a biopsy as well to give more information. [PG – Consultant] You will be seen by the surgical team first and then they will assess you and let you know what further
investigations you need, not everybody needs investigations and they will
tailor the investigations according to your presentation. [Sally – patient] My experience was I
needed to go through and have the mammogram then have an ultrasound and
then because of that I went on and had the biopsy whereas it can be that you
would only have the mammogram and you wouldn’t need to go on to either of the
other procedures. They will only put you through the test that they need to put
you through to make sure that they get the full outcome. [Louise – Radiologist] Most ladies who are
under the age of 40 will be recommended to have an ultrasound scan. They’ll have
an ultrasound scan because the surgeon would like to know what a
particular area the tissue looks like and the radiologists’ really looking for
anything that looks a little bit different. Women over the age of 40 will
automatically be sent for a mammogram as well and if on either of the tests the
mammogram and the ultrasound or one or the other we find anything that we’re
not sure what it is then we usually recommend a biopsy. [PG – Consultant]
Mammogram is principally an x-ray of your breast, you compress the breast
between two glass plates it sounds compressed sounds painful but it’s not
as bad as it sounds and you take the image in one plane and then you compress
the breast in different right angles to the previous one and you take it so you
get views into you see in one image top to bottom in the other image you see from
medial to the lateral the inside to the outside. So these two views together gives
you a lot of information. [Louise – Radiologist] You will have to take your top things off so very sensible to wear a skirt or trousers rather than a dress and then you feel a
little bit more secure when at least you can keep your bottom things on and
she’ll ask you to take the bra off as well and she will position your breast
first one side and then the other on the mammogram machine so you’ll be standing
up often with your arm up so that she can get you in position she wants to
ensure that as much of the breast tissue as possible is included between the two
plates of the mammogram machine. [Sally – patient] You have to stand in certain position at a
certain angle and then they literally squash you but it only lasts just for a
really short time just to enable them to get that picture. [Louise – Radiologist] The mammogram machine
is designed to squash the breast tissue that’s good because it means that we
can reduce the radiation dose to as little as possible it also means that
the picture is a higher quality than if we don’t squash it and it means that
you’ll keep still because any fractional movement will blur the x-ray and mean we
can’t see the really really fine subtle detail that’s so important to us. [Sally – Patient] The
radiographer that did the testing, you know that did the mammogram
lovely she was talking to me the whole time making sure that I was in you know
okay and checking that I was in the right position and all the rest of it
even though I’d only found the lump in one side they did they did check both
breasts to make you know to see what was happening a little pain but it’s
what you get back from it that’s good. [Louise – Radiologist] While we’re actually taking a
mammogram it’s for a second or so it’s very very quick
you’ll hear a noise and as soon as soon as the noise goes off the x-ray has been
taken within a second or so and the compression can come off but we’ll do
that two times for each breast. [PG – Consultant] The radiation from mammogram is so small that it’s unlikely to be of practical risk to be of cancer.[Louise – Radiologist] Many ladies find it
uncomfortable but the pain will go very quickly after the compression comes off
as soon as the x-ray is taken for some ladies that will feel a little bit
bruised afterwards and some ladies find it doesn’t really hurt at all
the radiographer will then check the mammogram pictures make sure she’s happy
that she’s got enough of the breast tissue included in the picture and it’s
not too blurred if she’s not happy then she’ll repeat the mammogram straight
away. [Sally -patient] I got called through in to go and have an ultrasound they put the gel on
and then they use the kind of wand thing that they have to to go over the area
and sort of adjust it and move it around to make sure they can see. The clinician
that did it was lovely and was talking the whole time saying about what they
were doing and what they were going to do and then when it was done. [Louise – Radiologist] One of our healthcare assistants will come and call you by name from the waiting room
they’ll ask you to take off your top clothes off and your bra and they’ll lie you down on
the couch with a piece of paper over you just to keep you covered for the moment
and then the radiologist who’s a doctor trained in ultrasound scanning and
looking at x-rays will come in and we’ll use an ultrasound probe to actually use
sound waves to create a picture of the tissue under the probe.[PG -Consultant] Ultrasound is
more of a focus if I feel there is a problem in one quadrant of the breast
then I would say could you please look at an additional mammogram look
at that particular area with an ultrasound. It’s more focussed, it’s quite
labour intense because radiologists have to sit down and look at every bit
of the area. [Louise – radiologist] The radiologists will take pictures that they think will help tell
a story so if they see a little area that looks it looks a little bit
different then they’ll be taking pictures at several different angles of
that area and if it looks normal again they’ll be taking pictures to say
this is the area we’re looking at and this looks like normal tissue. If they
have any concerns at all then they’ll usually recommend that we do a biopsy
it’s always helpful if you know that’s going to happen because they’ll have
that conversation with you while they’re actually doing the scan. They’ll be
talking to you about what the biopsy entails while they’re doing the scan and
trying to get a little bit more information. [Sally – Patient] The piece that really
worried me and really I was quite scared about was the biopsy because obviously
I’ve got to that third test you know that they needed to do. There is a bit of
obviously it’s a needle going in and they got to get it into, you know
into the lump so it’s uncomfortable, it wasn’t as bad as I was
anticipating it was going to be. I just kept trying to think well this is going
to check and see where we are you know see what this actually is. Because it was
a worry. [Louise -Radiologist] The radiologist will explain that we’re going to put some anaesthetic in, that stings as it goes in just like
anaesthetic for anywhere else and we’re able to put it just at the spot we need
it because we’re using the scanner to show us where it needs to go and we can
then make a tiny hole in the skin and use a special biopsy needle to put the
needle exactly where we where we want the biopsy to be taken from and you will
feel the needle being pushed in place but it shouldn’t hurt because the
anaesthetic will have done that job. You’ll then hear a very loud click often
quite close to your ear so you’ll jump at the first time but
we’ll try and tell you what it sounds like before your first biopsy and to
be aware there’s a very loud click lots of ladies say it sounds like a stapler.
We usually like to take more than one sample depending on how big the area is
whether we think we’ve got it sometimes with a tiny little lesion we need to
have a couple of goes to make sure that we’ve actually got it but the
radiologist will take biopsies until they’re happy they’ve got something that
represents what they’re looking at on the scan. [PG – Consultant] The risk from the biopsy is
there it carries a risk of bleeding you have a
tiny wound it can be bruised quite a bit and it can be painful or sore but
generally on a routine purposes it’s a very well tolerated procedure and
painkillers for a few days in the form of paracetamol or ibuprofen is usually
sufficient. [Louise – Radiologist] So that sample has to go to the lab it then has to be embedded in
wax, it has to be shaved off and prepared with special dyes that will take 24 to
48 hours at least so that means if you’ve had a biopsy on a Monday it’s not
going to be ready on Wednesday you’re not really going to know until the week
after. We’d rather get the right answer than rush it through so we’re going to
take as long as it takes. [PG – consultant] If you have a biopsy we do not expect
the results to be available less than a week and then those biopsy results are
discussed in a multidisciplinary team meeting where a radiologist, pathologist
and a surgeon all sit together and present their individual assessment. [Sally – patient]
Because they tell you at this point that you’re going to need to wait for the
result of the biopsy to come back because they need to send it away to get
the sample checked as to what’s going on then that’s kind of the worst part.
It’s that waiting and not knowing knowing you’ve got a lump knowing you
can feel the lump there but not actually knowing how you’re going to deal with it
if it is going to be anything or not. [Nick – Registrar] In terms of discharge the same day its more than 90%. In terms of a diagnosis of cancer we’re probably looking about 5%
of the people that come through our clinic. The vast majority of people will be
reassured and discharged on the same day with no biopsy or any further action
needed. [Sally – patient] The consultant called me and gave me the good news that everything was
fine and I burst into tears because it was just such a relief. [PG – consultant] If you see a
hundred people in a clinic about five or six would have cancer, and the aim of
these clinics is to find people in very early stages of cancer so that we can
treat them and they can go on to have live a normalish span of life. [Sally – patient]
From meeting the admin staff on reception and the clinicians, the
radiographers everybody just wanted to do the best to be able to get you
through the process. If you find anything that’s different with your breast then
go and get it checked out with your GP it’s so much better to go and get it
checked out as soon as you find it then it is too kind of think, I’ll leave it
for a bit and see what happens don’t leave it just get it checked you

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