Also read Promoting Healthier Breasts
All too often we ignore our
breasts - find ourselves saying, "Oh, I'll have my breasts examined next time I go
for a Pap smear." Right? How often do we put off going for that Pap smear? Many
recoil at the thought of setting our legs up in those stirrups and having our breasts
squeezed and smashed during a mammogram. How many of us really perform BSE [breast
self-examination] on a regular basis? Let's talk about breasts! We need to be concerned
with breast health. During and after menopause, breast health becomes an even greater
Breast cancer is one of the leading causes of death for women.
The average woman has one chance in eight (or about 12 percent) of developing breast cancer
during her lifetime. It is the most common type of cancer among American women.
Each year, more than
193,000 women in the U.S. learn that they have breast cancer. Two-thirds of them will be
over age 50. But breast cancer also occurs in younger women. And in men, too.
While breast cancer cannot
currently be prevented, it can be treated, if detected early. Early detection is the key
to survival. When it is detected early enough, it is often successfully treated; when it
is not detected early, it is often fatal. For this reason breast examinations are of
extreme importance to all women. Practicing breast exams helps increase your chances of
detecting breast cancer in its earliest stages. Only about 20 percent of biopsied breast
lumps are cancerous. And, if cancer is found early, there are choices for treatment.
With prompt, appropriate
treatment, the outlook is good. In fact, most women treated for early breast cancer will
be free from breast cancer for the rest of their lives.
The National Cancer
Institute (NCI) suggests a three-point breast cancer detection plan. Mammography is the
key to detecting breast cancer at its earliest stage because it can find a cancer up to
two years before it can be felt.
Mammography screening for
breast cancer offers no long-term survival benefit for women in their 40s, but that the
test saves lives among women age 50 and older.
Currently, the American
College of Physicians does not recommend mammograms for younger women.
NCI, however, currently
recommends that women should start having this test at age 40. For women of all ages,
other important exams include a breast examination by a doctor or other health
professional and breast self-examination. These guidelines should be considered along with
your background and medical history.
NCI currently recommends the following plan:
KNOW WHEN TO OBTAIN A MAMMOGRAM
Beginning at age 40, all women should be encouraged to have a mammogram every year.
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
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.
THE PHYSICAL BREAST EXAM
Both your gynecologist and your general health practitioner should perform regular
breast exams on you, but it is even more important that you perform them regularly on
yourself. It is important to begin a routine of self exams at an early age, because even
though the incidence of breast cancer is extremely low in women in their teens and
twenties compared to their thirties, forties, and fifties, it does occur. Also, it is
necessary to be able to decipher what is normal breast tissue for you and what is not.
Abnormal clumps or lumps of tissue are potential symptoms of problems and need to be
detected and dealt with. It is these types of lumps that you are checking for while doing
breast self exams.
Breast tissue is naturally lumpy, and it takes a little bit of time to become familiar
with what is normal for you. The consistency of your breasts will often change throughout
the menstrual cycle, and during/after menopause, becoming more lumpy just before
menstruation, and unpredictable during/after menopause. Therefore the best time to examine
your breasts is soon after you finish your period or, if no longer menstruating, at least
on a monthly basis. It's wise to set up a schedule of breast self-exam once a month. You
should examine your breasts at approximately the same time each month in order to monitor
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.
Breasts come in all sizes and shapes, just as women do. Your own breasts will even
change throughout your life. Your monthly menstrual 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.
REGULAR BREAST SELF-EXAMINATION
BSE [breat self-exam] 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.
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.
Recent research on the benefits of mammograms for women younger than age 50, however,
is currently being analyzed by NCI and other health organizations.
If you have had a hysterectomy or no longer menstruate, examine your breasts on the
first day of each month.
For a detailed description of how to perform BSE, breast self-examination and photos, click here.
Breast self-examination is a valuable, preventive health practice for women. Developing
a regular pattern will enhance your skills and help you notice changes. If you find a lump
or changes in your breast, contact your health care provider.
Women, during menopause, are even more vulnerable - especially those taking hormones...
and should give extra attention to their breasts. Become familiar with your breasts -
their shape and texture. OWN your breasts as part of the body you OWN.
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 common 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
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
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.
- U.S. Dapartment of Health & Human Services, National Cancer Institute
- Denton, S., & Miller, K.A. (1982). Breast cancer. In R.A. McNeeley (Ed.),
- CounSELFile: A self-health management guide. Tucson, AZ: W.K. Kellogg
Foundation and the University of Arizona.
- DoD Health Services Region IV
111 G Street Bldg 5901
Keesler AFB, MS 39534-2428
Parma Rishel, MSN, RN
Regional Breast Care Coordinator
If you do find a lump or notice any change in the appearance of one or both
breasts, you should make an appointment to have your breasts examined by a clinician.
Most breast lumps are discovered by women, themselves, incidentally or during the BSE.
Women in the childbearing age (18 to 45 years) commonly have lumpy breasts due to normal fibrocystic
changes. In the past this was referred to as FIBROCYSTIC BREAST DISEASE, but this is not a disease, but
a normal change seen in the majority of women. Other names that have been used to describe
this change are "mammary dysplasia," "chronic cystic mastitis," and
"benign breast disease." Fibrocystic breast changes include a
broad range of findings from painful breasts with solid lumpy patches to cysts (sacks
filled with fluid). Fibrocystic breast(s) may feel painful, dull, and full. When examined with
the fingers, the lumps may be tender, firm, and slightly movable. Often, a trained examiner (physician or nurse practitioner) can distinguish between the changes that are suggestive of malignancy or
those of a nonmalignant breast disorder. There are also several procedures which are
helpful in the differentiation of breast lumps: mammography, an x-ray of the breast;
ultrasound, which uses sound waves to make a picture of the structures inside the breast;
and needle aspiration, in which a fine needle is inserted into the lump and any fluid
present is withdrawn and analyzed.
If you have fibrocystic breasts, regular breast self exams allow you to become very familiar
with your breasts and increase the chances that you will be able to identify a change earlier.
Breast self exam is also important if you are in the high
risk group for breast disorders. High risk is defined as those women who have a family
history of breast cancer or benign breast disease, particularly a mother or a sister. It
also includes women who have had no children, who are of Ashkenazi Jewish decent. There is some speculation
at this time that smoking, a high fat diet, and alcohol consumption (greater than 3 drinks per week)
may be associated with a higher risk of breast disease.
Fortunately, many times fibrocystic breast discomforts can be easily managed, depending on
the character of the lumps, the amount of discomfort, and the family history. Conservative
measures include wearing a well-fitting supportive bra and loose-fitting clothing. Ice
packs or warm compresses applied to the tender areas may give relief. The elimination or
substantial reduction from the diet of caffeine (found in coffee, tea, cola drinks, and
chocolate) for several months has resulted in diminished symptoms for up to 80% of the
women studied. Reducing the amount of fluid your body retains before your period can also
ease discomfort. This can be done by reducing the intake of salty food, especially the
week before your period. A few studies have suggested that a daily supplement of vitamin E
(600 IU or one tablet) and a B multivitamin preparation may also alleviate symptoms. Other
generally healthful measures in this regard include reducing the amount of fat in the
diet, drinking less alcohol, and no smoking.
For very severe cases your physician may prescribe hormones such as progesterone, oral
contraceptives, or the drug danazol. Rarely, surgery is performed if the lumps are very
large or troublesome, or if the family history is positive for malignant disease.
If you are concerned about any difference in your treatment plan and the information in
this handout, you are advised to contact your health care provider.
For additional information about breast health in both men and women, visit
The Dept. of Defense Health Services Region IV Breast Health Information.