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
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
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.
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
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 yourself effectively.
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
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
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, go to the Breast Health Information Site by
clicking here and clicking on "Screening" and Breast Self-Exam.
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 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.
- U.S. Dapartment of Health & Human Services, National Cancer
- Denton, S., & Miller, K.A. (1982). Breast cancer. In R.A.
- CounSELFile: A self-health management guide. Tucson, AZ: W.K.
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 (see above)
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
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 fibrocystic breasts, go to http://psaweb.pcola.med.navy.mil/breasthealth/
and click on Fibrocystic breasts.
For additional information about breast health in both men and women,
The Dept. of Defense Health Services Breast Health Information Web