Use of Chest X-Ray in Breast Cancer Patients

No longer standard for staging, this test may be used for other reasons

Nurse examining chest x-rays in hospital
Paul Bradbury / Getty Images

In the past, chest X-rays were almost always ordered as part of the breast cancer staging process. Today, the imaging test may or may not be one you receive before you begin treatment. While chest X-rays have a low success rate in detecting whether breast cancer has spread to your lungs, your doctor may still recommend one for several reasons.

Limitations for Breast Cancer Staging

After you're diagnosed with breast cancer, your doctor 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 or 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. In addition, chest X-rays in people with early-stage breast cancer have a high incidence of false positives, which can increase emotional distress.

As an added concern, some studies have found that chest X-rays may increase breast cancer risk in young women who carry BRCA gene mutations. While a 2013 study did not confirm earlier findings, the potential of an increased risk along with the lack of benefit (not to mention cost concerns) are things you and your doctor should consider if the possibility of a chest X-ray is raised.

Despite all of this, many cancer centers still order chest X-rays as part of the staging process for breast cancer. Chest X-rays may also be ordered to evaluate other concerns in breast cancer patients.

Purpose of Test

Other than staging, 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 surgery (and a general anesthetic) or chemotherapy
  • 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)
  • 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, and there is often confusion when this occurs. Cancer that spreads to the lungs from the breast—even if the breast tumor was removed years earlier—is still breast cancer. (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 the primary (breast) cancer, not the secondary (lung) cancer.

When breast cancer spreads to the lungs, there may not be any symptoms at first. When symptoms occur, they often include a dry cough, shortness of breath, or recurrent respiratory infections.

Roughly 4% of people have metastases (most commonly to the bones, liver, lungs, and brain) at the time of diagnosis.

Alternatives

If your doctor 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 because they 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 a scan of the lung are just as likely to be a primary lung tumor as breast cancer metastases in people who have early-stage breast cancer. Since it's known that chest X-rays can miss up to 25% of these cancers, a chest X-ray alone could give false confidence that everything is all right, which may be more detrimental than not performing the test at all.

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

Risks and Contraindications

Chest X-rays are considered very low-risk procedures. They do use a small amount of radiation, but it's not much more than you're exposed to all the time from the environment.

If you are or could be pregnant, talk to your doctors—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 so they can take steps to protect your baby from radiation.

Before the Test

An x-ray is a fairly straightforward and routine test.

Timing

You should be able to get a chest X-ray at any time of day.

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 doctors' offices may 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 on 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 doctor 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 doctor 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 tech 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, where you'll likely lie down on a table.

Throughout the Test

The tech 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, don't ask the tech to interpret them for you, as they're not allowed to do so.

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 doctor will look at the X-rays, and your doctor should contact you with the results. If you're nervous, 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 doctor wanted the X-rays in the first place. They may provide answers or lead to further testing. If your doctor doesn't explain what the next step will be, be sure to ask.

Breast Cancer Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

A Word From Verywell

It's not uncommon for someone with breast cancer to be told they need a chest X-ray. But unless you know why it's being done, your brain may try to fill in the answers, which can lead to a lot of 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 outcomes.

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