BREAST EXAMS What you should know


What you should know

Breast cancer is the most common type of cancer among American
women.  Each year in the United States, more than 175,000 women
learn they have breast cancer.  Two-thirds of them will be more
than 50 years old, but breast cancer does occur in younger women
(and in about 900 men a year).  The average woman has 1 chance in
9 (or about 11 percent) of developing breast cancer during her

Understanding the need for and practicing breast exams will help
you 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 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 for you to follow.  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.  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.

Doctors do not yet know how to prevent breast cancer.  But you
can increase your chances of detecting breast cancer in its
earliest stages by following the three steps of NCI's early
detection guidelines:


     Beginning at age 40, all women should be encouraged to have
     a mammogram every 1 to 2 years until age 50. After 50,
     mammography should be done annually.

     A mammography 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 doctors believe 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 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 age 40 or older.  These guidelines may
     change as new scientific information becomes available.
     The final decision regarding mammograms, of course, should
     be made on an individual basis.

     A doctor may also suggest a mammogram if a symptom of breast
     cancer is found, whether through BSE (breast self-exam), the
     annual exam, or by chance.  If you have a symptom of breast
     cancer, you should not hesitate to have a mammogram if your
     doctor recommends it.


     Women should have breast examinations during their routine
     checkups.  Women 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, you should ask for
     one.  During the exam, the health professional feels the
     breast and underarm with the fingers, checking for lumps.
     This is called palpation.  The breasts also are checked for
     other changes such as dimpling, scaling, or puckering of the
     skin or a discharge from the nipples. 


     Women should do breast self-examination monthly.

     Breasts come in all sizes and shapes, just as women do. Your
     own breasts will even change throughout your life. Your
     monthly menstrual cycle and menopause, childbirth,
     breastfeeding, age, weight changes, and birth control pills
     or 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 using BSE.  It is easy to do, and
     as the name implies, you do it yourself.  Women taking
     charge of their own health are doing BSE regularly.  They
     are also eating healthy foods, exercising regularly and
     avoiding tobacco use.

     BSE 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.  In fact, some health
     professionals suggest that, at first, women do BSE every day
     for a month so that they really know the "geography" of
     their breasts.  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.  Remember, 8 out
     of 10 biopsied breast lumps are not cancer.  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.  (More information
     about benign breast conditions can be found in the National
     Cancer Institute booklet Questions and Answers About Breast

     Discussing BSE with your doctor will help you understand the
     procedure better.  Ask your doctor or other health
     professional to review with you the steps of BSE, as well as
     to explain what you are feeling in your breasts.  This will
     assure you that you are doing your BSE correctly and
     thoroughly, and you will gain more confidence in examining
     your breasts.

Remember every part of the breast cancer detection plan:

     M-~    Regular mammograms.
     M-~    Routine breast examination by a health professional.
     M-~    Monthly breast self-examination.

Used together, they offer you the best chance of finding breast
cancer early. 


Currently, mammography is the most common and useful technique
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

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.  The technique remains experimental.


One day there may be a single method for the early detection of
breast cancer. Until then, using a combination of methods will
increase your chances of detecting cancer in an early stage. 
Here is your personal checklist for breast cancer detection:

     M-~  Mammography for all women who are age 40 or older.
     M-~  A regular breast exam by a health professional.
     M-~  Monthly breast self-examination.
     M-~  Personal alertness for changes in the breast.
     M-~  Readiness to discuss quickly any such changes with a


For answers to your questions about breast exams or breast
cancer, write to the Office of Cancer Communications, National
Cancer Institute, Bethesda, Maryland 20892, or call the toll-free
telephone number of the Cancer Information Service at:


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