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Breast Cancer Diagnosis
A breast abnormality is not necessarily cancer. To determine its nature, the diagnosis relies on a clinical examination, appropriate imaging, and—when a lesion is suspicious—a biopsy analyzed under a microscope. At Gustave Roussy, these steps can be coordinated as part of the InstaDiag Breast care pathway.
Key Takeaways
Mammography and ultrasound can detect and characterize an abnormality. Only a pathological examination of a tissue sample can confirm a diagnosis of breast cancer.
InstaDiag Breast: A Rapid Diagnostic Process
Created in 2004, the InstaDiag Breast program is designed for individuals in whom a suspicious breast abnormality has been detected during a clinical examination or imaging test. It brings together, within a short period of time and—when circumstances allow—all in a single day, the consultations and tests needed to determine the nature of the abnormality.
A specialized team reviews the tests that have already been performed, the patient's medical history, and the reason for the visit.
The necessary tests are scheduled based on the observed abnormality and the available documentation.
The available results are explained, and the next steps are outlined.
Who is InstaDiag Sein intended for?
For individuals with a lump, an unusual finding on a mammogram or ultrasound, or any breast abnormality requiring prompt specialist evaluation. This pathway is initiated after an abnormality is detected and does not replace organized screening.
What types of tests can be performed?
Tests are selected on a case-by-case basis. Not all of them are routine.
The doctor examines the breasts and lymph node areas, particularly the armpits. He or she also takes a medical and family history and notes the circumstances under which the abnormality was discovered.
A mammogram uses X-rays to examine the structure of the breasts. It is often supplemented by a breast and lymph node ultrasound. Depending on the situation, tomosynthesis or angiomammography with contrast dye may be recommended.
An MRI is not routinely performed. It can be useful in certain situations to better characterize an abnormality or determine the extent of a lesion that has already been identified.
A biopsy involves removing a tissue sample under local anesthesia. It may be guided by ultrasound, mammography, or, more rarely, MRI. Pathological analysis confirms or rules out a cancer diagnosis and identifies characteristics that are useful in selecting a treatment.
Fine-needle aspiration involves collecting cells using a thin needle. It can be used, for example, to examine certain lymph nodes or lesions, depending on the medical indication.
The Four-Step Diagnostic Process
Identification of an abnormality, specialized consultation, appropriate imaging, and biopsy and pathological analysis if necessary. The treatment strategy is determined only after all results have been interpreted.
If the diagnosis has already been made
Patients who have already been diagnosed with breast cancer are referred for a consultation with the specialist responsible for their planned treatment: a surgeon, medical oncologist, or radiation oncologist. Any imaging studies and biopsies already performed may be reviewed, and additional tests are ordered if necessary.
The one-day treatment intake is designed to consolidate the evaluations needed to prepare for treatment. Depending on the situation, it may include a specialist consultation, a review of imaging studies, an anesthesia consultation, nursing care, and other evaluations necessary for the treatment plan.
One-Day Treatment Intake
This document outlines the schedule for the day, the healthcare professionals you will meet, and what you need to prepare before your visit.
Votre parcours de soins en pathologie mammaire
A decision made as a team
The results of the evaluation are reviewed during a multidisciplinary team meeting. The specialists develop a treatment plan, taking into account the type of cancer, its extent, its biological characteristics, and the patient’s situation. The referring physician then explains and discusses this plan with the patient.
After Treatment: Personalized Follow-Up Care
Follow-up care is tailored to the type of cancer, the treatments received, and each patient’s individual situation. It primarily involves regular follow-up visits and mammographic screening. Additional tests are not routinely performed; they are ordered based on symptoms, clinical findings, and risk level.
A monitoring program in partnership with the city
Some of the tests, treatments, or follow-up care can be arranged close to home, in coordination with the primary care physician, gynecologist, radiologist, and partner facilities.
In cases of high risk, without a diagnosed cancer
Certain situations warrant specific evaluation and monitoring, including a genetic predisposition, a significant family history, certain high-risk breast lesions, or a history of thoracic radiation therapy at a young age.
An oncogenetic consultation may be recommended when a personal or family history suggests a predisposition. The testing may look for mutations in BRCA1, BRCA2, PALB2, or other genes, depending on the situation.
Some abnormalities found during a biopsy are not cancers, but may be associated with an increased risk. The monitoring plan and recommended course of action are determined based on the specific type of lesion.
The Interception program offers personalized prevention and follow-up care to people at increased risk of cancer, through a coordinated effort between the city and the hospital.