"I eat right, I exercise. I get plenty of
sleep. I don't think I'm going to get breast cancer."
"Breast cancer doesn't run in my family,
so I know it's not running in me."
"I don't have health insurance. Mammograms
are very expensive."
Some of us will use any excuse to avoid dealing with
the issue of breast health. That's understandable. Just the thought
of a breast lump can be terrifying. Yet there are a few simple steps
you can take that could make a big difference in your breast health.
There are many myths and rumors about breast cancer.
But here are three absolute facts.
One. No one is immune to breast
cancer. Every woman is at risk, particularly as she gets older.
Two. Breast cancer can be successfully
treated—if it's found early. Early detection is your best protection.
And three... It's up to you to take
the first step toward breast health awareness!
You might have heard that research studies do not show that women
who practice BSE live longer if breast cancer is diagnosed.
But scientists do agree that finding a cancer when
it's still small does offer the benefits of avoiding more complex
surgery and possibly chemotherapy. So do take the time to learn this
simple skill, and get in the habit of performing a BSE every month,
starting at age 20.
The goal of breast self examination is not to identify
every single lump—that could be a challenge, particularly for women
whose breasts are lumpy. Instead, use BSE to become familiar with how
your breasts feel normally, so that you can spot any changes early,
and report them to your doctor. Think of BSE as BHA - breast health
- The best time for BSE is at the end of your menstrual
period when your breasts are less tender.
- If you no longer menstruate, do your BSE on the
same day of each month, so you don't forget.
- There are two steps to breast self examination—LOOKING
Use a mirror wide enough to see not just the breasts, but the entire
area where breast tissue can be found: from the collar bone to the
bra line and from the armpit line to the breast bone. Check the shape
and size of your breasts, and the color and texture of your skin,
first with your arms down, then with your arms in the air. Two other
positions—pushing down on the hips, to tighten your chest muscles,
and bending forward at the waist, with your arms relaxed, will help
you spot "dimpling"—the tugging on the skin or nipple,
often caused by a growing tumor.
Look for changes in breast shape or size. It's not
unusual for one breast to be larger than the other.
Check the skin for changes such as redness, a rash,
or an orange-peel appearance.
Notice the nipples. Inverted nipples are normal, but
a change in nipple appearance is not. Squeezing the nipple to check
for discharge is no longer part of BSE. But if you have seen spotting
on your bra from a spontaneous discharge, report it to your doctor.
Lower your arms, and examine your armpits. Feel for pea-sized lumps
that may be enlarged lymph nodes—a sign of a possible change
within your breast tissue.
FEELING is done most effectively while
Place a folded towel under the shoulder and extend
the arm out at an angle, to spread the breast tissue more evenly over
your chest, for easier examination.
Women with larger breasts should roll to the side
until the nipple points straight up, as if floating on top of the
breast. This position helps the breast tissue lie evenly flat.
In the past, some women examined their breasts in
the shower. This is no longer done. In the standing position, any
breast bigger than an A-cup is difficult to examine thoroughly.
To feel the breast, use the pads of your fingers because
they're more sensitive than the tips. Use the three middle fingers,
keeping the thumb and pinkie out of the way. Make three dime-sized
circles. One lightly. One deeper. One as deep as comfortable. This
will enable you to check the full thickness of the breast.
Move your fingers over—about the width of two
fingers—and circle again. With deep pressure you might even
feel your ribs just behind your breasts.
When you move your hand, don't lift it away from the
skin so you don't miss a spot. Instead, "walk" your fingers
to the next spot. Keep the fingers straight, with the pads—not
the tips—flat against the breast. Your fingers should be almost
parallel to your breast.
Examine the entire area where breast tissue may be
found. Start near the armpit. Go up and down in strips about as wide
as your three fingers. Up to your collarbone and down to the bra line.
Overlap the strips slightly so no area is left unexamined. Go all
the way over to the breast bone. Change hands, and check the other
breast. Again, starting from the armpit, up and down, all the way
across to the breast bone.
Studies have shown that the "vertical strip"
technique is more effective in covering the entire breast area than
the circular or the wedge patterns.
If you had breast surgery or breast implants, use
the same technique, and examine the entire breast area.
At first, many women are confused by the lumpiness
they feel in their breasts. What would a tumor feel like if you found
one? Some people say it feels like a marble in a sock, or a raisin
under a napkin, or a peanut in a pack of gummi bears... It doesn't
really matter. You are not trying to make a diagnosis. Your task is
simply to spot a change—any change—in the normal look
or feel of your breasts, and report it promptly.
Whether you find something by BSE or by accident,
report it promptly to your doctor. That's what breast health awareness
is all about.
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Clinical breast examination is done by a trained physician, nurse
practitioner or other healthcare professional. The technique is the
same that you use for your breast self examination—looking and
feeling. The examiner will check the entire area where breast tissue
may be found—from the clavicle to the bra line, and from the
breast bone to the armpit line. Generally, the accuracy of the exam
is proportional to the time spent. Depending on the size of your breasts,
a complete exam may take 3-10 minutes.
Susan G. Komen for the Cure recommends that you have
a clinical breast exam at least every 3 years beginning at age 20,
and annually starting at age 40. If your healthcare provider doesn't
perform a breast exam when it is due, ask for one!
Women who have a history of breast cancer should insist
on a thorough examination, with particular attention to the incision
line, or the scar line.
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Today, mammography, or breast x-rays, is considered to be
the best method for finding breast cancer early. Only a small amount
of radiation is used in a mammography examination and the benefits
outweigh the radiation risk.
There are several things you can do to ensure that
your mammography experience is the best it can be.
Make sure that the mammography facility is certified—which
means that it meets the required quality standards for the mammography
equipment they use, the people who work there, and the records they
If your breasts are particularly sensitive, avoid
scheduling the mammogram the week before your period.
Give the technologist all the information you can
about any past problems with your breasts, breast surgery, any family
history of breast cancer, and the date and name of the facility where
you had your last mammogram. Comparing your old x rays with the new
ones can help the radiologist spot new changes.
On the day of the exam, wear a top that can be easily
removed because you will be asked to take off all your clothing above
the waist. Do not use underarm talcum powder or deodorant because
they may show up as false spot on the x-ray picture. Inform your technologist
if there is any possibility that you are pregnant.
A mammogram takes only a few minutes. The technologist
will need to place your breast on the digital detector or film holder.
The pressure may be uncomfortable, but should not be painful, and
it will last only a few seconds. Compression on the breast is extremely
important, because the more you can eliminate overlapping tissue,
the better and more accurate the mammogram will be—with less radiation
dose. You can ask the technologist to stop at any time and reposition
For routine, or screening mammograms, only two pictures
of each breast will be taken: top to bottom, and side to side. The
same procedure will be repeated on the other breast.
Sometimes the technologist will get additional views.
Don't be alarmed. Taking a few extra pictures doesn't mean that a
problem was found. The additional views may be needed simply to examine
a specific area, since breasts vary so much in tissue composition.
Before you leave, ask how and when your doctor will
get the results of your mammogram. If you do not receive the results
within ten days, call your doctor or the mammography facility.
Mammograms are read by a radiologist—a physician
who has special training and experience in interpreting mammograms.
An experienced radiologist, proper technique and state-of-the-art
equipment can lead to early detection, and the best chances for successful
Who should have mammograms? Most experts now agree
that women should have mammograms every year, beginning at the age
of 40. If you have a mother or sister who had breast cancer before
menopause, your doctor may recommend that you begin having regular
New (2007) recommendations by the American Cancer
Society include MRI in addition to mammography for women at high risk
for developing breast cancer.
Mammography is the most sensitive method for finding
breast abnormalities. But it doesn't detect all of them. If you feel
a lump, or any other change, have it checked by your doctor, even
if your mammogram was normal. Early detection could be the key to
peace of mind and a healthy life.
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In addition to mammography, other tests, such as ultrasound, may be
used. Ultrasound uses harmless and painless sound waves that may help
distinguish between different types of breast lumps. Ultrasound is
particularly helpful in younger women, whose breasts are more dense,
and more difficult to examine with mammograms.
MRI is also a useful tool in breast imaging. This
technique uses a combination of magnetic and radio waves to obtain
an extremely detailed picture of the breasts. MRIs are expensive,
and are not a substitute for mammography, but they can be very effective
in spotting subtle abnormalities such as leaking silicone implants,
or tiny lesions.
Recently the American Cancer Society issued a recommendation
that all women who are at very high risk for developing breast cancer
should have an annual MRI in addition to the mammogram.
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