Test / Diagnostic Procedure: Breast Triple Assessment

A breast triple assessment involves three types of tests to screen for and diagnose breast cancer.

The three stages of a triple assessment are:

1. Initial assessment (medical history and physical examination)

2. Imaging (mammography and/or ultrasound)

3. Needle test (fine needle aspiration or core biopsy)

While each of these tests can be useful individually, they provide much more accurate and reliable results when done in combination.

At OneWelbeck, we perform a Triple Assessment at our outpatient One Stop Breast Clinic. (in Enhanced Breast Screening.

We recommend that you visit us for an assessment if you have any concerns about your breast health or are experiencing any of the following symptoms:

• A lump or thickening in your breast

• A lump or swelling in your armpit

• Changes in the size, shape or feel of one or both breasts

• A change in the position of the nipple, such as turning inwards

• Discharge from one or both nipples, which may be bloodstained

• Pain in the breast or nipple

• Skin changes in your breast, such as puckering, dimpling, a rash or redness of the skin

• Problems with breastfeeding

Traditionally, tests for breast cancer are carried out at separate appointments after the results from each one are delivered. This means it can take a few weeks to rule out or provide a diagnosis of cancer. The main benefit of the triple assessment is that all necessary tests are carried out at the same appointment, so your results are available much more quickly.

While the majority of breast lumps are benign, receiving your results quickly means you can begin treatment as soon as possible if it is needed. Having a biopsy on the same day as your initial assessment and imaging also means your specialist will have an idea of the grading (severity) of your cancer if you are diagnosed, allowing them to start you on the most effective treatment plan as quickly as possible.

A breast triple assessment is straightforward but can feel daunting. Knowing what to expect from each stage can help you feel prepared.

Initial assessment

At OneWelbeck, a consultant breast specialist will ask you a few questions about any symptoms you have and will take your medical and family history.

They will then do a physical examination of your breasts to look a feel for any abnormalities or lumps. This involves going over your whole breast area including the nipples, and also over your neck, collarbones and under your armpits.

Imaging

After your initial assessment, and depending upon your age, you will have a mammogram and/or ultrasound scan.

During a mammogram, the breasts are compressed one at a time in a mammogram machine . This holds the breast tissue still while X-rays are taken. This may be uncomfortable but only lasts for a few minutes.

Consultant Radiologists then assess the Mammogram images. Mammograms can help detect abnormalities before they are  felt and can also show tiny clusters of calcium called microcalcifications. Lumps or specks that show up on mammograms may be cancerous tumours, but they can also be other non-cancerous conditions such as cysts, or a collection of fatty cells or fibrous tissue

A Breast ultrasound scan can help the Radiologist identify if an abnormality or breast lump is a fluid-filled cyst, or if it is solid,

Biopsy

If an abnormal area has been identified, a tissue sample with a biopsy will need to be performed to identify whether cancer cells are present. This involves taking a small sample of tissue via a needle once local anaesthetic has been injected into the site.

A fine needle aspiration may be performed to draw out any fluid from a possible cyst.

Ultrasound scanning is used to guide the needle into the correct area

These samples are sent to the laboratory and the results are sent to your Consultant.

They will inform you of the findings.

If cancer is found, they may arrange for you to have further tests such as an MRI, PET and/or CT scan, blood tests, and potentially a bone scan.

Once they have the full picture of the type and severity of the cancer they will recommend the most effective and appropriate treatment for you at a follow-up consultation where you can discuss all your options and ask any questions.