‘Brahma-Visnu-Mahesh Is the Hindu trimurti, the father, the son and the holy spirit is the christian one. The sampradaya of breast surgeons have something akin to the holy trinity too. It is called the triple test. Long ago, when there was no imaging and pathology was in its infancy, the only way to diagnose a breast lump was by a careful history and clinical examination. Stoop backed, old professors explained and demonstrated ‘ a case of scirrhous carcinoma of the breast’ and the students would flock to examine the patient. Major parts of books were devoted to the art of history taking and the look and the feel of different diseases. Breast cancer was rare, and anything suspicious underwent either complete removal of the lump for examination or if the disease was obvious, straightaway to surgery.

But there was a meddlesome fellow called William Conrad Roentgen who tinkered with a radioactive substance. (Talk about dangerous habits!) And X-Ray was born. Technology has progressed and we are in today’s day of glitz and glamor.

Don’t get me wrong, a well taken history and a careful, meticulous medical examination are still the cornerstones of the diagnosis. It is a sad fact that this once cherished art is dying a quick death. But this ‘’clinical encounter’’ must be supplanted by two other things, hence the name-triple test. The remaining two are-Imaging and pathology, in that order.

Imaging can be done in different ways, it can be an ultrasound or a mammogram. Usually it is a combination of both. There are other modalities too-such as MRI and thermal imaging, but those are reserved for special circumstances.

Pathology, in today’s day and age is something known as a core needle biopsy. This is essentially a small machine which goes in and takes small pieces out. The pathologist then can process it, put it under a microscope and study it. There are specific markers on the cells which help us in making decisions about treatment and prognosis.

An accurate (99%-nothing in medicine is 100%) diagnosis can be reached only if we employ all these three modalities together. Clinical practice is ripe with ignored lumps, lumps which were just imagined and not biopsied. There are sad stories of missed cases and lost lives.

We must pray to this holy trinity in all cases of breast lumps.