Detection of Breast Cancer
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
American Cancer Society guidelines for the detection of breast cancer
in asymptomatic women are:
20 years of age and older should perform breast
self-examination every month.
20-39 should have a physical examination of the breast every three
years performed by health care professional such as a
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.
40 years of age and older should have a mammogram
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
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:
2. Examination upright
3. Examination lying down
inspection: Look at your breast in the mirror. Extending your arms above
your head and leaning forward can accentuate any changes in the breast.
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.
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.
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.
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.
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.
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.
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:
Assessment of risk factors
examination lying down
assessment of axillary and supraclavicular nodes
(above the collar bone or clavicle)
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:
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.
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.
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.
breast facilities are required to be ACR (American College of Radiology)
and FDA (Food and Drug Administration) accredited.
For every 100 mammograms, 10 will require additional studies.
In women younger than 35, mammography is helpful in 70% with a palpable