Screening mammography is the best early detection method for reducing the number of deaths associated with breast cancer (as outlined by current evidence).
Mammography is generally not undertaken in patients under 40 years of age (as age is the largest risk factor for breast cancer), however women older than 40 should have mammograms every two years. Women with other risk factors such as a strong family history, gene anomalies or previous breast cancer may have mammograms at an earlier age or be monitored more closely.
Clinical breast examinations carried out by a trained health professional often take place after a woman has performed a self breast examination and has found an abnormality.
Examination involves looking for the same changes as for self breast examination; although other areas such as lymph nodes may also be examined. The clinician will often send a woman for further investigation, such as mammography if an abnormality is detected.
Self Breast Examination
The self breast examination is a quick and simple way a woman can check for breast changes by herself.
The importance of this is outlined by the fact that over half of breast cancers are initially investigated due to an breast abnormality detected by the woman or her doctor. It should be performed by all women, every month (preferably after menstruation has finished) from the age of 18 onward.
Changes that should draw a womans attention include:
- the appearance of a new lump or changes in a previously benign lump
- changes in breast or nipple size or shape
- abnormal nipple discharge
- skin changes in the breast such as dimpling or puckering
- persistent breast pain
There are a number of breast self examination techniques, however evidence indicates that no technique in necessarily better than the other in terms of breast cancer detection. A suggested technique is as follows:
Step 1: Look at your breasts – in the mirror you will be looking for lumps, changes in the shape of your breasts, any dimpling or puckering of the skin or change in nipple as you move your arms.
a) Undress and stand in front of a mirror with your arms by your side.
b) Put your hands on your hips and tighten your chest muscles.
c) Put your hands high in the air above your head.
Step 2: Lying down- lie on the bed with a pillow under your head. Be comfortable and relaxed. First put your left arm above your head. Use the 3 finger pads of your right hand to check your left breast. Roll the pad of your hand in small circles over your entire breast including your armpit checking for lumps and changes in texture.
First do the whole breast with light pressure then again with firmer pressure. Squeeze the nipple and check for any discharge. Then repeat with your right arm above your head, using your left hand to check your right breast.
Some women do not feel comfortable touching their own breasts. They can try doing the self-exam in the shower. They may find this a more comfortable alternative as fingers slide more easily over wet skin. In the shower, raise your left arm above your head. Using the flat of your right hand, roll your hand in a circular motion checking the whole area of your breast, armpit and up to the collarbone for lumps, hard knots or thickening of breast tissue.