Breast cancer is the leading cause of cancer deaths in women ages 40 to 55. The good news is that breast cancer is highly treatable if detected early. There are three methods of early detection: breast self-exam, clinical breast exam, and mammogram. One of the most important risk factors for breast cancer is age. The risk goes up significantly after age 40. Women younger than 40 are at relatively low risk of breast cancer (about 1 in 200). However, if your mother or sister had breast cancer before menopause, talk with your doctor about starting breast self-exams and other screening before age 40.
Most breast lumps are discovered by women themselves, often quite by accident. The breast self-exam is a simple technique to help you learn what is normal for you and how to recognize any changes. Many organizations recommend monthly breast-exams for all women starting at age 18 to 20. Other organizations feel there is not enough information on the benefits of breast self-exams to make a recommendation about when to start. You may wish to talk with your doctor and decide for yourself when to begin doing monthly breast self-exams. Establish a regular time each month to examine your breasts. A few days after your breasts. A few days after your period when your breasts are not swollen or tender is a good time. Women who do not menstruate (after menopause and hysterectomies) can examine their breasts the first day of each month.
Most women’s breast tissue has some lumps or thickening. When in doubt about a particular lump, check the other breast. If you find a similar lump in the same area on the other breast, both breasts are probably normal. Be on the lookout for a lump that feels much harder than the rest of the breast. Have any areas of concern checked by your health professional. The important thing is to learn what is normal for you and to report changes to your doctor. The breast self-exam takes place in two stages:
Stage 1: In front of the mirror
Examine your breasts visually in a mirror. Few women have breasts that match exactly. It is normal for one breast to be slightly larger than the other. Learn what is normal for you. Stand and look at your breasts in four positions:
- With your arms at your sides
- With your hands on your hips
- With your arms raised overhead
- While bending forward
In each position, look for changes in the contour and shape of your breasts, the color and texture of the skin and nipples, and any discharge from the nipples. Squeeze the nipple of each breast gently between your thumb and index finger. Look for a discharge.
Stage 2: Lying Down
To examine your right breast, place a pillow or folded towel under your right shoulder. If your breasts are large, lie on your left side and turn your right shoulder back flat to spread the breast tissue more evenly over your chest wall. Use pads of the three middle fingers of your left hand to examine your right breast. Move your fingers in small, dime-sized circles. use light to medium pressure in each spot to feel the full thickness of the breast tissue. Don’t lift your fingers away from the skin. You are feeling for lumps, thickening, or changes of any kind. Examine your entire breast using a vertical strip pattern. Examine all tissue from the collarbone to the armpit and from the bra line to the breastbone. Start in the armpit and work down to the bottom of the bra line. Move your fingers width toward the middle and work up to the collarbone. Repeat until you have covered all the breast tissue. Another method is to imagine that your breast is a clock. Start on the outside of the breast at 12:00, move slowly to 1:00 and then around the clock back to 12:00. Then move one inch in toward the nipple and go around the clock again. Move pillow or towel to the left shoulder and repeat this procedure for the left breast.
If you discover any unusual lumps, thickening, discharge from the nipple, or changes of any kind, report them to your doctor immediately. Most lumps are not malignant, but your doctor needs to make a diagnosis. If you examine your breasts monthly, you will learn what is normal for you and quickly recognize if something changes. The breast self-exam takes some practice. Ask your doctor for help in learning the technique.
Clinical Breast Exam
The second component for early detection of breast problems is your health professional’s physical exam. This exam is very similar to the self-exam. A clinical breast exam is recommended every one to two years starting at age 40.
A mammogram is a breast X-ray that can reveal breast tumors too small to be detected by breast self-exam. Studies have shown that mammograms save lives in women over 50, reducing breast cancer death rates by up to one-third. Studies in women younger than 50 have not shown that mammograms saves lives or improve its quality. This is probably because until menopause, women’s breast tissue is more dense, making tumors harder to find. It may also be due to other factors believed to be related to the spread of tumors that occur before menopause. Because benefits have not been shown and abnormal mammograms that require biopsies are quite common, many experts no longer recommend mammograms before age 50. After age 50 (more specifically, after menopause), mammograms are recommended every one to two years. They are also recommended for women younger than 50 whose female relatives (mother, sister) have a history of breast cancer before menopause.
Scheduling an Exam
- Schedule your mammogram one to two weeks after your period.
- Do not wear deodorant, perfume, powder, or lotion, which can affect the quality of the X-ray.
- Wear clothing that allows you to remove only your top.
Breast Health Tips
- Do your breast self-exam every month after age 40. Most breast lumps are discovered by women themselves. If detected early, breast cancer usually can be successfully treated.
- Have a clinical breast exam every one to two years starting at age 40.
- Have a mammogram every one to two years after age 50.
- Limit alcohol to one drink per day. Heavy drinking increases the risk of breast cancer.