Early Detection of Breast Cancer


The early detection of breast cancer is comprised of three parts:
1. Monthly breast self-examination
2. Yearly physician examination
3. Mammography according to the American Cancer Society

The American Cancer Society guidelines for the detection of breast cancer in asymptomatic women are:

1.

Women 20 years of age and older should perform breast
self-examination every month.

2. Women 20-39 should have a physical examination of the breast every three years performed by health care professional such as a
3. Women 40 and older should have a physical examination of the breast every year, performed by a health care professional such as a physician, physician assistant, nurse or nurse practitioner.
4.

Women 40 years of age and older should have a mammogram
every year.


Monthly Breast Self-Examination

Breast cancer feels like a hard rock in the breast 78% of the time. The other 22% of the time, breast cancer feels like a thickening like rubber. Women find 80%-90% of the masses in their breasts. Women who routinely conduct their breast self-examinations can detect a mass when it is one-half inch in size. Physicians can detect tumors when they are an inch in size. Women who do breast self-examination will find a mass sooner that their physicians will. They will be their own breast experts. Breast self-examination is effective in detecting 70% of breast abnormalities.


Breast Cancer Location

The best time to do breast self-examination is a week after your period or if you do not have periods, pick a day of the month. Monthly breast self-examination is a three-fold:

1. Visual inspection
2. Examination upright
3. Examination lying down

Visual inspection: Look at your breast in the mirror. Extending your arms above your head and leaning forward can accentuate any changes in the breast.

Nipple Changes


Inverted Nipple

The nipples should be pointing in the same direction. As younger women, this is usually up and out. As we age, the nipples tend to move down and out (heading south). Do you notice any retraction of the nipples or change of the nipple on one side in comparison to the other side? Look for scaling or redness of the nipple/areolar complex. Check for nipple discharge. There are 10 to 15 ducts that open on the surface of the nipple. Is the discharge bloody or clear yellow form a single duct and a single breast? If so, this needs to be evaluated by a physician as a third of these discharges may represent an underlying malignancy. Multiple duct nipple discharge that involves both breasts that is cloudy green or yellow or milky is usually benign.

Skin Changes

Notice the color and consistency of the skin of your breast. Do you notice any redness of the skin of the breast? Do you notice any thickening of the skin of the breast and prominence of the hair follicles? These changes need to be evaluated by a physician.


Inflamatory Breast Cancer

Breast Changes

Looking at the breasts, do you notice any abnormal bulges or skin dimpling? These findings may be more prominent with your arms extended above your head. These changes need to be evaluated by your physician.


Dimple

Abnormal Bulge

Examination Upright

Several different patterns of breast self-examination are available. The pattern is not critical as long as the breasts are examined in a consistent fashion. Generally recommended in the shower or tub with soap, the breast is examined in a systematic fashion. Firm pressure, with the flat of the fingertips, needs to be exerted in order to feel the internal structures of the breast. Examine your right breast with your left hand and vice versa. The addition of soap or lotion makes this portion of the exam easier. Most women complain of their breasts being lumpy. This is because of the normal configuration of the breast. The breast tissue is arranged in lobules or groups like the petals of a flower. If you feel these separations, examine your breasts in a radial or star burst pattern. Compare one breast to the other. Are they the same? If you notice any masses or thickening that are not present in the opposite breast, contact your physician or breast center.


Check for lymph nodes in your armpit (axilla). These are small kernels (like those that develop in your neck with a sore throat) that may be present. Notice any masses? If so, see your physician as 10% of breast cancer may present as an axillary node alone.

Examination Lying Down

The same examination is accomplished lying down. The breast tissue is compressed against your chest wall allowing you to feel the internal structures of the breast. Many times masses can only be felt in one position and that is the reason for the recommendation to examine the breasts in both an upright and lying down position.

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Physician Examination

Should you notice a change in your breast self-examination or as a part of your yearly well woman exam, your physician should do a breast examination. Physician evaluation is effective in detecting breast abnormalities 70% of the time. Your breast evaluation should include:

1.
2.
3.

 Breast History
 Assessment of risk factors
 Breast examination
 

a.
b.
c.
d.

visual inspection
upright examination
examination lying down
assessment of axillary and supraclavicular nodes
(above the collar bone or clavicle)

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Mammography

Mammography is a radiological technique used to detect breast abnormalities in symptomatic and asymptomatic patients. The first dedicated mammogram units were developed in 1969 and clinical trials evaluating mammography began in the early 1970's. The procedure entails the use of compression to stabilize the breast and spread its interior structures to allow the use of a lower amount of irradiation in imaging. The irradiation dose from a mammogram is .1 rad per view. The irradiation risk to the breast from mammography is negligible (you would have to live to be 7500 years old and have a mammogram once a year to have a one in a million chance of developing breast cancer from mammography). Mammography can reduce the risk of dying (mortality) frm breast cancer by 30%-40%. Mammography can detect breast cancer three years sooner than it can be detected on a breast examination. The key to survival with breast cancer is early detection. Mammograms are of two types:

1.

Screening mammogram: Two views of each breast accomplished in asymptomatic patients. The purpose of screening mammography is to detect breast cancer before it becomes clinically apparent.

2.

Diagnostic mammography: Additional mammograms obtained after screening if mammographic abnormalities are detected or accomplished for those patients that have known breast conditions such as a mass, implants or a history of breast cancer.

The American Cancer Society recommends that all women over forty have a yearly mammogram. Women who are at increased risk for developing breast cancer from a premenopausal family history may need to begin screening mammography earlier. Women who have had treatment for breast cancer with conservative breast surgery need diagnostic imaging of the affected breast every six months for the first two years and then return to yearly diagnostic imaging.

All breast facilities are required to be ACR (American College of Radiology) and FDA (Food and Drug Administration) accredited.

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Quick Facts:

For every 100 mammograms, 10 will require additional studies.
In women younger than 35, mammography is helpful in 70% with a palpable abnormality.