Breast cancer starts in the cells of breasts. Confirming a diagnosis of cancer involves a number of tests and scans that may include mammography, ultrasound, MRI and biopsy. During a biopsy, a tissue sample is taken and sent to a lab to find out if cancer cells are present or not.
You may be referred to our North York General Hospital’s Medical Imaging Services or our BMO Breast Diagnostic Clinic (BDC) where a health care team, including a surgeon will meet with you. At the BDC you will be asked to fill in a detailed profile of your personal and medical history. Please come prepared with the knowledge of the history of cancer in your family.
Mammography uses low-doses of X-rays to take detailed images of breast tissue. Mammograms are used to screen for breast cancer and often to take additional images. At North York General Hospital,we use digital mammography, as well as tomosynthesis, creating a 3D image of the breast. Your mammogram will be performed at the Karen, Heather and Lynn Steinberg Breast Centre.
Preparing for your mammogram
What to expect
You will be asked not to use any deodorants, antiperspirants, body lotions, or talcum powders since the metals in these products may interfere with images.
You will be given a gown and asked to remove your top at the appointment.
Your breast will be compressed between two glass plates.
You will need to remain still for less than a minute while X-rays are taken of the breast.
Generally, four images are taken for a screening mammogram, two of each breast.
The pressing of the breast may be uncomfortable or hurt.
What to wear
Wear comfortable clothing with a top that is easy to remove. You will not have to remove clothing below the waist.
Questions for your doctor
Can I take a mild pain relief pill one hour before my appointment?
When and how will I receive my results?
Please contact the patient navigator if you have any questions or concerns regarding a mammogram or any other procedure.
Breast ultrasound (also called sonography) is a diagnostic tool that uses high-frequency sound waves to produce images of breast tissue. It may be used to see lumps that are not clear on the mammogram. Ultrasound is non-invasive and involves no radiation.
Preparing for your ultrasound
What to expect:
You will be asked to lie on your back or side and expose your breasts.
A gel is applied to the breast being examined.
A small hand-held instrument that sends out sound waves is passed over the gel-covered area.
You will be asked to lie still for about 10 minutes.
What to wear
Wear comfortable clothing with a top that is easy to remove; you will not have to remove clothing below the waist.
Questions for your doctor
When and how will I receive my results?
Breast ultrasound services are offered primarily at our Branson site location (555 Finch Avenue West). Your physician will let you know where your test will take place. Please contact the patient navigator if you have any questions or concerns regarding having an ultrasound or any other procedure.
Breast magnetic resonance imaging (MRI) uses magnets and radio waves to produce detailed 2-D and 3-D images of the breast. It is considered very safe. This is a non-invasive procedure, which does not involve radiation. Breast MRI services are offered at our General Site (4001 Leslie Street).
Preparing for your MRI
What to expect:
Our MRI technologists will introduce themselves and bring you into a private consultation room to go through some MRI safety questions and explain the procedure.
If you have a pacemaker or programmable shunt, an MRI cannot be done.
If you have an implanted device, please provide this information before arriving for your appointment:
Make and model of implant.
Manufacturer of implant.
Date of surgery for the implant.
Examples of implanted devices include: aneurysm clips, heart valves, breast tissue expander, cochlear implants, eye implants (with the exception of replaced intraocular lenses), stents, stimulator devices, porta catheter or any type of pump which may be implanted).
If you have worked with, or around metal, and had an injury to your eyes with metal you will need to have X-rays of the eyes prior to your MRI.
You will be asked to remove all clothing except underwear, socks and shoes. You will be given a patient gown and pants to put on.
You will be asked to remove anything metallic, such as jewellery, belts, earrings or zippers. It is strongly recommended that you do not bring any valuables with you because you will need to remove and place all jewellery in a patient locker.
Before the scan begins the technologist will give you ear plugs to reduce the noise that is created by the MRI.
During the MRI, you will need to expose your breasts and lie on your stomach.
As the MRI begins you will hear a loud thumping sound.
You will have a contrast dye injected into your arm near the end of the MRI to help with the clarity of the images. Although rare, some people have temporary discomfort during this infusion. You will be given a call bell to alert the technologist if you are not feeling well.
Your examination is expected to last 45 minutes.
What to wear
You will be asked to remove all clothing except underwear, socks and shoes and you will be given a patient gown and pants to put on.
Questions for your doctor
When and how will I receive my results?
Please contact the patient navigator if you have any questions or concerns regarding the procedure.
A biopsy is a procedure where breast tissue is removed and examined by a pathologist to determine whether cancerous cells are present. There are several different types of biopsies. A radiologist or surgeon can use ultrasound, mammography or MRI to guide a biopsy ensuring the correct area is sampled.
Biopsies are performed at both the Branson and General sites of North York General Hospital by a radiologist or surgeon.
What to expect
Wear comfortable clothing such as a loose fitting top with buttons or a zipper.
Depending on the type of biopsy, you may experience some discomfort with the procedure.
Most biopsy appointments last approximately one hour.
Questions for your doctor
Do I need to stop taking my medications before my biopsy? When do I stop taking my medications?
Can I eat or drink anything the night before my biopsy?
When and how will I receive my results?
Please contact your patient navigator if you have any questions or concerns regarding the procedure.
Pathology is the process of examining breast tissue to see whether it is cancerous. If cancer is found, the pathology report will help determine treatment options. The pathology report describes the characteristics of the cancer that was found. These include the size of the tumour, hormone levels, HER2 status, and lymph node involvement.
Your surgeon or medical oncologist will discuss the results in the pathology report with you and your family.
Questions for your surgeon or medical oncologist
What type of breast cancer do I have?
What can be done to treat the cancer?
Has the cancer spread?
Do I have to decide on the treatment right away or can I look for more information and think about it? Where can I get more information?
This is a big decision to make; can I get a second opinion?
What are the chances that the cancer will come back?
What if I choose not to have treatment? What would happen?
Will treatment affect my fertility?
To prepare for your conversation with your surgeon or medical oncologist, you may wish to bring the Pathology Report Checklist with you.
Contact your medical oncologist or surgeon if you have any questions or concerns regarding results.
Most cases of breast cancer are not hereditary. However, about 5 to 10% of cases appear to have a hereditary connection. Through genetic counselling and risk assessment we aim to identify people with an increased risk for inherited cancer. Certain genes, when mutated (a change in the DNA of a gene), put us at a higher risk for cancer. These genes are inherited from our parents and can be passed on to our children.
A genetic risk assessment helps to determine whether someone is eligible for genetic testing. This information may help individuals and their care providers determine the best treatment options. If you have a family history of breast cancer you may wish to consider a referral for a genetic risk assessment.
You will be asked what family members have cancer including the type of cancer and the age at diagnosis. This information may be collected by phone or questionnaire before your visit.
An appointment will be arranged for you to meet with a genetic counsellor.
A personalized family assessment will be done and will include discussing you and your family’s eligibility for testing.
Questions for your genetic counsellor
What are the pros and cons of doing genetic testing? How can this information help me in my treatment plan?
When will my results be explained to me and by whom?
