Breast Cancer

• Mammography: Women should have a baseline mammogram at age 35 and a yearly mammogram starting at age 40.
• Clinical breast exam (CBE): A physician should examine breasts for lumps during periodic health exams. According to the American Cancer Society, a CBE should occur about every three years for women in their 20s and 30s and every year for women 40 and over.
• Breast self-exam (BSE): Women are encouraged to know how their breasts normally feel and examine their breasts for lumps or any other changes beginning in their 20s. Report any breast change promptly to your health care provider.
• If you are at increased risk of breast cancer due to family history, genetic tendency, or past breast cancer, talk to your doctor about the benefits and limitations of starting mammography screening earlier, having additional tests (for example, breast ultrasound or MRI), or having more frequent exams.

Mammography
Breast cancer can take years to develop and if detected early (before it has spread to the lymph nodes or other organs) the five-year survival rate is 98 percent. A mammogram is an x-ray exam of the breast. The goal is to find cancer when it is still too small to be felt by a woman or her doctor. It is also used to evaluate breast abnormalities in women who have breast symptoms such as a lump, pain, or nipple discharge. During a mammogram, the breast tissue is spread apart by flattening it between two plastic plates attached to the mammogram machine. This squeezing ensures a sharper image, and that the exam can be done with a lower x-ray dose. Although uncomfortable, it only lasts for a few seconds and is needed to produce a good mammogram. A technologist (usually a woman) positions the breasts. Two views of each breast are usually taken (unless more are needed to view larger amounts of breast tissue). The entire procedure for a mammogram takes about 20 minutes.

Tips for Having a Mammogram

• If it is not posted visibly near the receptionist’s desk, ask to see the FDA certificate that is issued to all facilities that offer mammography. The FDA requires that all facilities meet high professional standards of safety and quality in order to be a provider of mammography services. Without certification, a facility may not provide mammography.
• Use a facility that either specializes in mammography or does many mammograms a day.
• If you are satisfied that the facility is of high quality, continue to go there on a regular basis so that your mammograms can be compared from year to year.
• If you are going to a facility for the first time, bring a list of the places, dates of mammograms, biopsies, or other breast treatments you have had before.
• If you have had mammograms at another facility, you should make every attempt to get those mammograms to bring with you to the new facility (or have them sent there) so that they can be compared to the new ones.
• On the day of the exam, don’t wear deodorant or antiperspirant; some of these contain substances that can interfere with the reading of the mammogram by appearing on the x-ray film as white spots.
• You may find it more convenient to wear a skirt or pants, so that you’ll only need to remove your blouse for the exam.
• Schedule your mammogram when your breasts are not tender or swollen to help reduce discomfort and to assure a good picture. Try to avoid the week just before your period.
• Always describe any breast symptoms or problems that you are having to the technologist who is doing the mammogram. Be prepared to describe any pertinent medical history such as prior surgeries, hormone use, family or personal history of breast cancer. Also discuss any new findings or problems in your breasts with your doctor or nurse before having a mammogram.
• If you do not hear from your doctor within 10 days, do not assume that your mammogram was normal -- call your doctor or the facility.

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Clinical Breast Exam (CBE)
In a clinical breast exam, your healthcare provider (usually your gynecologist) examines your breasts. The physician uses fingertips to press on breast tissue in vertical and circular patterns in an effort to identify lumps or other breast changes.

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Breast Self-Exam (BSE)
The best time to examine your breasts is when they are not tender or swollen. You can examine your breasts regularly even if you are pregnant, breast-feeding, or have breast implants. Ask your doctor to review your technique periodically. Most important, if you detect any changes in your breasts, report them to your healthcare provider right away.

How to Examine Your Breasts

• Lie down and place your right arm behind your head. Lying down is important because is causes the breast tissue to spread evenly over the chest wall and thin out. That makes it easier to feel all the breast tissue.
• Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
• Use three different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. A firm ridge in the lower curve of each breast is normal. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.
• Move around the breast in an up and down pattern starting at an imaginary line drawn straight done your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collarbone (clavicle). There is some evidence to suggest that the up and down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast and not missing any breast tissue.
• Repeat the exam on your left breast, using the finger pads of the right hand. While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
• Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it very difficult to examine.
• If a change occurs, such as a lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, a discharge other than breast milk, or a change in the size of one breast, you should see your doctor or nurse as soon as possible for evaluation. Remember that most of the time these breast changes are not cancer.

Source: American Cancer Society

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