Clinical Features: Early detection is crucial. A lump in the breast is often the first sign. Nipple discharge and pain may follow. In later stages, the lump becomes firm, irregular, and fixed, with palpable axillary lymph nodes

Mammography serves several important purposes:

• It is recommended for older and high-risk women.
• It can help reassure women with cancer phobias by confirming normal breast health.
• Mammography is essential when a lump is detected in the breast.
• Yearly or bi-yearly screening between the ages of 45 and 60 is a cost-effective measure.

However, there are contraindications to mammography, as it is not suitable during pregnancy due to radiation risk. Additionally, it may not be reliable as the sole investigative tool for women under 40 because of dense breast tissue. Mammography's accuracy increases with age, though interpretation can be challenging for women with a history of breast surgery or those undergoing hormone replacement therapy (HRT). For optimal results, mammography should encompass two views of both breasts: the mediolateral oblique view and the craniocaudal view. Regular mammography can reduce cancer mortality by 30%. The findings may include alterations in breast tissue density, microcalcifications, skin thickening, fibrous streaks, nipple changes, and the detection of various conditions like fibroadenomas, lymph nodes, galactoceles, cysts, and solid tumors.

In cases where mammography may not be suitable, ultrasound imaging with a 10-MHz probe is valuable, especially for individuals under 35, pregnant or lactating women, and those with duct papillomas. Ultrasound can differentiate between cystic and solid malignant tumors but cannot detect microcalcifications, a crucial early cancer indicator. Breast and ovarian cancer screening with ultrasound is vital due to their potential for mutual spread.

Doppler ultrasound can reveal a tumor's vascular pattern, offering insights into its potential malignancy. Emerging technologies like computer-aided detection and diagnosis (CADD) and electrical impedance imaging are gaining ground. Ductoscopy and cytology should be considered when duct papillae are suspected.

For metastasis assessment, X-ray chest, CT brain, and abdominal ultrasound are recommended. Magnetic Resonance Imaging (MRI) provides precise measurements of tumor size, particularly for invasive cancer, aids in staging, and predicts responses to primary chemotherapy. It is valuable for young women and those with prior breast surgeries.

Fine Needle Aspiration Cytology (FNAC) under ultrasound or clinical guidance offers a cellular study of breast lumps, but mammography or ultrasound should precede FNAC to avoid potential image distortion. A combined approach of clinical examination, mammography, FNAC, and ultrasound can identify cancer in approximately 99.5% of cases.

When a more extensive tissue sample is needed, a Tru-cut biopsy removes a core of tissue for frozen histology and receptor analysis. For larger tumors, excisional biopsy may be necessary.