Use of Chest X-Ray in Breast Cancer Patients

Chest X-rays were often ordered as part of the breast cancer staging process. Today, this type of imaging test may or may not be one you receive prior to treatment.

Chest X-rays have limitations in detecting if breast cancer has spread. However, your healthcare provider may still recommend a chest X-ray for several reasons, such as infection.

This article will review the purpose, risks, and limitations of X-rays for breast cancer staging, as well as what you can expect before, during, and after such testing.

Limitations for Breast Cancer Staging

After being diagnosed with breast cancer, your healthcare provider will try to determine the stage of your cancer, so that they can determine the proper treatment. In some cases, you may not know the stage until after you have surgery, a sentinel node biopsy, and possibly a positron emission tomography (PET) scan, along with other tests.

Chest X-rays are no longer recommended as part of staging, according to the guidelines of the National Comprehensive Cancer Network. A 2015 study looking at chest X-rays done as part of staging found that this test did not improve the detection of occult metastases, but it did increase costs.

Still, many cancer centers and healthcare providers order chest X-rays as part of the staging process for breast cancer and for a number of other reasons.

Purpose of Test

Chest X-rays may also be ordered to evaluate other concerns in breast cancer patients, such as investigating bone pain or identifying lung infections.

Your oncologist may have several reasons to order a chest X-ray. Some of these include:

• To evaluate any breathing problems, such as a cough or shortness of breath, that you have either prior to or during treatment
• To look at your heart and lungs before you have chemotherapy or surgery with a general anesthetic
• To look for evidence of pneumonia if you develop a fever while on chemotherapy (a low white blood count, called neutropenia, can increase your risk of infection)
• To look for evidence of radiation pneumonitis (inflammation of the lungs) during or after radiation therapy or due to chemotherapy drugs
• As part of a clinical trial if a chest X-ray is required for participation
• To look for evidence of lung metastases (spread of breast cancer to the lungs) if you develop any symptoms that are suggestive of this

For Metastatic Breast Cancer

The lungs are a common site of breast cancer metastases in people with metastatic breast cancer. Cancer that spreads to the lungs from the breast—even if the breast tumor was removed years earlier—is still breast cancer. In other words, if you took out the tumors in the lungs and looked at them under the microscope, you would see cancerous breast cells, not lung cells.

This is referred to as breast cancer with lung metastases—not lung cancer. This is important because the best treatment options are those that treat the primary (breast) cancer, not the secondary (lung) cancer.

Roughly 6% of women have metastases (most commonly to the bones, liver, lungs, and brain) at the time of diagnosis.

Alternatives

If your healthcare provider is concerned that you may have a tumor or metastases in your lungs, a better test is a chest computed tomography (CT) scan.

Chest X-rays are limited in their ability to detect small areas of cancer—either metastases or a primary lung tumor. In fact, screening chest X-rays are not recommended for people who smoke. This is because they sometimes fail to pick up cancer early enough to make any difference in survival.

Recent studies suggest this is especially important. When looking at the spread of breast cancer to the lungs, researchers have found that abnormalities detected on imaging tests of the lung(s) are just as likely to be a primary lung tumor as breast cancer metastases in people who have early-stage breast cancer. Because X-rays can sometimes miss these cancers, an X-ray alone could give false confidence that everything is normal.

In those who have higher stages of breast cancer (stage 2A and higher), a PET/CT scan is considered a more helpful test to look for evidence of metastatic disease.

Risks and Contraindications

X-rays are considered very low-risk procedures. They do use a small amount of radiation, but it’s not much more than the exposure of normal daily life.

If you are or could be pregnant, talk to your healthcare providers—both your oncologist and your obstetrician—before the X-ray, as they may want to delay it. If not, let the X-ray technician know the day of your test that you are pregnant so they can take steps to protect your baby from radiation.

Before the Test

An X-ray is a fairly straightforward and routine test. Minimal to no preparation is typically needed prior to the test.

Timing

A chest X-ray typically takes less than 15 minutes. If you have a scheduled time, be sure to arrive a little early to check in. If you’re dropping in, it’s a good idea to call ahead to see how long the wait is. Certain times of day, such as first thing in the morning, might be less busy than others.

Location

Some healthcare providers’ offices have X-ray machines on site. Others will send you to a hospital or other medical facility to have the X-ray done.

What to Wear

You’ll probably have to undress from the waist up and wear a hospital gown, so wear a top that’s easy to remove. Don’t wear a necklace.

Food and Drink

You should be able to eat and drink normally before and after the chest X-ray.

Cost and Health Insurance

A chest X-ray typically costs between $200 and $400, but prices vary greatly. If you shop around, you may be able to find them for significantly less, but some places charge significantly more as well.

If you have insurance, be sure to check what your plan will cover and what you’ll have to take care of out of pocket. If you do shop around in an attempt to save money, be sure to check with your healthcare provider about the place you choose, to make sure it’s reputable and reliable.

What to Bring

Be sure to have your insurance card with you when you arrive for the chest X-ray. Have any written orders your healthcare provider may have given you, and be prepared to answer questions about your medical history.

An X-ray is a fairly quick procedure, so you shouldn’t need to worry about entertaining yourself while it’s going on. (The waiting room may be another matter, though.)

During the Test

Pre-Test

When the X-ray technician is ready for you, you’ll be called back and, if necessary, given time to change into a gown that opens in the front. Then, you’ll be taken into the exam room.

Throughout the Test

The technician will give you instructions about how to position your body. You may be draped with special aprons that block radiation from parts of your body that aren’t being looked at.

From another room, the technician will instruct you to lie still and will take the images. You may need to be X-rayed in a few different positions.

Post-Test

If you want to see the images, you can ask. However, the technician is not allowed to interpret them for you.

Once the images are taken, you can get dressed and leave.

After the Test

You shouldn’t have any lingering effects from the chest X-ray.

A radiologist and your healthcare provider will look at the X-rays, and your healthcare provider should contact you with the results. If you’re nervous about the results, be sure to ask how long you should expect to wait so you’re mentally prepared.

Interpreting Results

Your results and what they mean will depend on why your healthcare provider wanted the X-rays in the first place. They may provide answers or lead to further testing. If your healthcare provider doesn’t explain what the next step will be, be sure to ask.

Breast Cancer Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.

Download PDF

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Summary

Chest X-rays are no longer part of the breast cancer staging guidelines. However, your provider may order a chest X-ray to investigate a number of issues for you, such as pain or cough.

The procedure is simple and usually takes 15 minutes or less. Though an X-ray does expose you to radiation in order to complete the test, the amount is small and the risk is minimal.

A Word From Verywell

It’s not uncommon for someone with breast cancer to be told they need a chest X-ray. Unless you know why it’s being done, however, your brain may try to fill in the answers, which can lead to unnecessary anxiety and worry. Your oncologist could simply be following up on a cough you mentioned.

The best way to avoid misunderstandings is to ask a lot of questions about the tests being recommended. Being your own advocate for your cancer care not only reduces anxiety, but may even improve your outcome.