BREAST CANCER

NCI currently recommends the following plan:
Step One: Know when to obtain a mammogram
Beginning at age 40, all women should be encouraged to have a mammogram every 1 to 2 years until age 50. After age 50, mammography should be done annually. A mammogram is an x-ray of the breast. It can reveal tumors too small to be felt and can show other changes in the breast that may suggest cancer. In mammography, the breast is pressed between two plates; some pressure is applied to get a clear picture. Usually, two x-rays are taken of each breast, one from the top and one from the side. Although some women are concerned about radiation exposure, the risk is very small.Doctors recommend routine mammography because it is effective in finding breast cancer early. Long-term studies have shown that using mammography along with a breast exam by a health professional can reduce deaths from breast cancer among women.
These guidelines may change as new scientific information becomes available. The final decision, however, regarding mammograms, should be made on an individual basis. A doctor also may suggest a mammogram if a symptom of breast cancer is found, whether through breast self exam (BSE), an examination by a physician, or by chance.

Step Two: The Physical Breast Exam
Women should have breast examinations by their physicians during routine checkups. Women age 40 and older should have them annually. The next step in early detection is breast examination by a health professional. You may find it convenient to schedule this exam during your routine physical checkup. If a breast exam is not done during that checkup, ask for one. During the exam, the health professional feels the breast and underarm with the fingers, checking for lumps. This is called palpation. The breasts also are checked for other changes such as dimpling, scaling, or puckering of the skin or a discharge from the nipples.

Step Three: Breast Self Exam (BSE)
Women should do breast self-examination monthly. Breasts come in all sizes and shapes, just as women do. Your own breasts will even change throughout your life. Your monthly men- strual cycle, menopause, childbirth, breast feeding, age, weight changes, birth control pills, and other hormones may change the shape, size and feel of your breasts. It is important to learn what is normal for you. This can be done by doing breast self exams. It is easy to do, and as the name implies, you do it yourself. BSE is done once a month so that you become familiar with the usual appearance and feel of your own breasts. Familiarity makes it easier to notice any changes in your breasts from one month to another.

Some health professionals suggest that, at first, women do BSE every day for a month so that they really know the "geography" of their breasts. Early discovery of a change from what is normal is the whole idea behind BSE. The best time to do BSE is 2 or 3 days after the end of your period, when your breasts are least likely to be tender or swollen. A woman who no longer has periods may find it helpful to pick a particular day, such as the first day of the month, to remind herself that it is time to do BSE. If you discover anything unusual, such as a lump, a discharge from the nipple, or dimpling or puckering of the skin, you should see your doctor at once.

How To Do Breast Self-Examinations
1. Stand before a mirror. Look carefully at both breasts. Check for anything unusual, such as any discharge from the nipples, puckering, dimpling, or scaling of the skin.
2. Watching closely in the mirror, clasp your hands behind your head and press your hands forward. Look for any changes in the shape or contour of your breasts.
3. Next, press your hands firmly on your hips and bow slightly toward your mirror as you pull your shoulders and elbows forward. Again, check for any changes in the shape or contour of your breasts.
4. Raise your left arm. Use three or four fingers of your right hand to explore your left breast firmly, carefully and thoroughly. Beginning at the outer edge, press the flat part of your fingers in small circles, moving the circles slowly around the breast. Gradually work toward the nipple. Be sure to cover the entire breast. Pay special attention to the area between the breast and the underarm, including the underarm itself. Feel for any unusual lump or mass under the skin.
5. Gently squeeze the nipple and look for a discharge. (If you have any discharge during the month -- whether or not it is during a breast self-examination -- see your doctor.) Repeat steps 4 and 5 on your right breast, using your left hand.
6. Steps 4 and 5 should be repeated lying down. Lie flat on your back with your left arm over your head and a pillow or folded towel under your left shoulder. This position flattens the breast and makes it easier to examine. Use the same circular motion described earlier. Repeat the exam on your right breast. If you notice changes, call or see your physician. Many women have irregular or "lumpy" breasts. The term "benign breast condition" refers to those changes in a woman's breasts that are not cancerous. Many doctors believe that nearly all women have some benign breast changes after age 30. But any change is best diagnosed by your doctor.

Other Methods Used For Early Detection
Currently, manual breast exams and mammography are the most com- mon and useful techniques for finding breast cancer. However, several other methods are also being used. Ultrasound detects breast changes by sending high-frequency sound waves into the breast. The pattern of echoes from these sound waves is converted into an image of the breast's interior. Ultrasound may be helpful in distinguishing between solid masses and cysts (fluid-filled sacs). Unlike mammography, ultrasound cannot detect small calcium deposits that may be present in the breast and that sometimes indicate cancer, nor does it identify small tumors. Thermography measures heat patterns given off by the skin. Changes in the image, including "hot spots," may suggest the presence of a breast problem. There is no known risk of using thermography, but it is not reliable enough to replace mammography.Diaphanography, or transillumination, shines a bright light through the breast. Transillumination can show the difference between a solid tumor and a cyst. Current studies indicate that this method does not identify the very small cancers that can be detected by mammography.

Source: U.S. Dapartment of Health & Human Services, National Cancer Institute