Breast Health
Breast cancer is the most common type of cancer among American
women. Each year in the United States, more than 182,000 women
are diagnosed with this disease. Although it may not be possible to
prevent breast cancer, many women survive it. Early detection
increases the rate of survival. Women with small, localized breast
cancers (where the cancer has not spread beyond the breast) have a
90 percent chance of living more than 10 years after the cancer is
treated.
Breast Exams
Many health care providers perform breast examinations routinely on
women of all ages during general office visits or well-woman exams.
The provider will check each breast using fingertips to feel for lumps,
and look for other suspicious changes, such as dimpled, scaling, or
puckered skin, or fluid leaking from the nipple. When combined with a
mammogram (depending on your age and risk factors), a breast exam
by a health care provider is the best way to detect cancer in its early
stages.
Breast self-exams. The American Cancer Society recommends
monthly breast self-examination (BSE) for all women age 19 and
older. Your provider can show you how to do a BSE. It's easy, and it
takes only about five minutes a month to do. Many women are afraid
to examine their breasts because of what they might find. But most
breast lumps are not cancerous. If you do find any lumps, see your
provider.
Fibrocystic breast disease is a term often used to describe a number of
different conditions causing breast lumpiness or lumps. These
conditions are not linked to cancer, and are the most common cause of
breast lumps in women. Women who have fibrocystic breast changes
usually have a condition in which lumps and cysts in the breast swell
and become painful before menstruation. Fibrocystic breast changes
affect 1 in 5 women to some degree, and can usually be managed by
lifestyle changes such as cutting down on salt and caffeine. In severe
cases, your provider may recommend surgery.
Performing a breast self-exam. The best time to do a BSE is one
week after your period starts, because any premenstrual swelling or
tenderness should be gone by then. If you have already gone through
menopause, do a BSE on the first day of each month. If you have had
a hysterectomy, ask your provider to advise you about the best time
of the month for you to perform a BSE.
What to look for. It's normal for your breasts to swell, feel lumpy, or
become tender, especially around the time of your period. By
performing a BSE each month, you will become familiar with the feel,
shape, and size of your breasts, making it easier for you to notice
changes, should any occur. Look for the following things while
examining your breasts:
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new lumps or changes in the size or shape of existing lumps
change in the shape or contour of your breasts, or unusual
swelling
changes in skin color or texture
dimpling, puckering, or crusting of the skin, or rash, especially
around the nipple
any fluid leaking from the nipple
Remember that even if you have some of these signs, it doesn't
necessarily mean you have breast cancer. Most breast lumps are not
cancerous. You should call your health care provider if you notice any
lumps or changes that concern you. He or she can tell you whether
you should schedule an appointment.
Mammograms
The most effective way to detect breast cancer early is mammography
- a low-dose X-ray of the breast. Mammograms can detect breast
cancers while they are very small, sometimes two years earlier than a
tumor could be felt by a woman or her health care provider. In the
past 25 years, mammography technology has improved considerably.
The X-rays are much more sensitive, and far less radiation is used.
But mammography is not perfect. In some cases, a lump you can feel
during a breast exam may not appear on a mammogram. Such a lump
would still need to be checked, even if the mammogram is normal.
Mammography, like most other tests, may also show abnormal results
when there is no cancer.
The American Cancer Society (ACS) recommends that women start
having mammograms every year at age 40. You may want to discuss
your options for breast cancer screening with your health care
provider. Regardless of whether you decide to have a mammogram at
this time, remember that regular breast self-exams and breast exams
by your provider are important practices to follow for early detection of
breast cancer.
Risk Factors
It's important for you to know your risk factors for developing breast
cancer, and to have regular screenings.
Family history. Your risk doubles if your mother or sister has had
breast cancer. It is even higher if they developed breast cancer before
menopause.
Precancerous cells on biopsy. Women who have had a previous
breast biopsy that was benign but showed certain suspicious cells are
at increased risk.
Age. Two thirds of all breast cancers occur in women over the age of
50. As you grow older, your risk increases.
Childbirth and menstruation. Your risk of breast cancer is higher if
you have never had children, or if you gave birth to your first child
after age 30. If you had your first period before the age of 12 or if you
experience menopause after the age of 50 your risk may be higher.
Other factors. Other factors linked to breast cancer include obesity
and a history of ovarian or endometrial cancer. Even so, the most
important risk factors are growing older and a personal or family
history of breast cancer.
You'll want to monitor yourself closely if you have any of the risk
factors discussed. Talk with your provider about when you need to
begin having mammograms.
Treatment of Breast Cancer
Several different types of surgery are used to treat breast cancer,
along with chemotherapy and radiation therapy. If the cancer has not
spread, only the lump may be removed; this is called a lumpectomy.
Other surgeries are variations on mastectomy, or the removal of all or
part of the breast. Radical mastectomy involves removing the entire
breast as well as the chest muscles. In modified radical mastectomy,
the breast, lymph nodes, and a small muscle in the chest are
removed. In a partial mastectomy, the lump, some lymph nodes, and
the lining of the chest muscle are removed, while the muscles are
usually left untouched. Many women choose to have their breasts
reconstructed after mastectomy.
How to Do a Breast Self-Exam
While in the shower, raise your right arm, placing your hand on the
back of your head. Starting at the outer edge of the right breast, use
the pads of the fingertips of your left hand. Feel for lumps or changes
as you move your fingers firmly in small circles, working in a spiral
toward the nipple. Check the other side in the same way, then gently
squeeze each nipple to check for any discharge.
1. After you shower, clasp your hands together and raise your arms
above your head with elbows bent. In a mirror, look for changes
in shape and contour, as well as any skin changes, such as
dimpling or rashes.
2. Still standing before the mirror, lower your arms. Place your
hands on your hips, pull your shoulders and elbows forward, and
lean slightly toward the mirror. Look again for any changes in
shape and contour, and for skin changes.
3. Finally, lying down, place a rolled towel or pillow under one
shoulder and place the hand on that same side over your head.
Examine your breast again as you did in the shower, this time
checking your armpit as well. Repeat this on the other breast.
4. Go to the doctor if you find anything that concerns you.