The type of breast cancer you have can only be discovered by a breast biopsy, in which tissue from the tumor is extracted and then tested in the lab. You need to understand what type of breast cancer you have before you can weigh your treatment options and make a decision. There are four breast biopsy procedures:

1. Fine-needle aspiration

2. Core biopsy

3. Incisional biopsy

4. Excisional biopsy

The first and least invasive is the fine-needle aspiration. This is usually done at the doctor's office, most often by a surgeon or other breast cancer specialist. During the fine-needle aspiration, the doctor holds the lump, gives local anesthetics to numb the tissue around the lump, and then passes the needle in and out a few times to get out cells that can be analyzed. This results in material that yields a cytology report, or an examination of a smear of cells.

The second type is a core biopsy, which consists of removing a core from the center of the suspicious mass using a needle device. This can also be done easily in the doctor's office. A core biopsy yields a greater amount of tissue than fine-needle aspiration.

In an incisional biopsy a wedge is taken out of the lump. This is done under local anesthetic. An incisional biopsy does not attempt to get good margins around the cancer and should rarely if ever be used for evaluation of a mass that is suspicious for cancer. If a lump is not palpated but is seen on mammography, it is done with guidance of wire localization with the abnormal area being marked with wires or needles under image guidance. The surgeon then follows the wire to get out the area that is localized. For an excisional biopsy, the surgeon takes out the whole lump.

Each type of breast biopsy has its pros and cons. The choice of which type is used depends on your particular situation. Your doctor will recommend one over another by evaluating how suspicious the tumor looks, how large it is, where it is in your breast, how many tumors are present, and your personal preference. Incisional biopsies are generally not ideal and in recent years a core biopsy has been the most common first step at getting tissue.

You may want to discuss this with your doctor, understanding the rationale for choosing one biopsy over another. Remember, whenever medical information is presented to you, it is important that it makes sense to you, so that you will be comfortable with having the procedure.

Remember, if your instincts are telling you that something is wrong, be sure to pursue your concerns with your doctor. If you are not satisfied with the information you are given, seek a second and even a third opinion if you feel it is necessary.