Be A Survivor - Breast Cancer Treatment Guide

Breast Health Awareness

Breast Health Awareness • Breast Self Examination • Clinical Breast Examination
• Mammography • Other Imaging Modalities

Breast Health Awareness

Some of us will use any excuse to avoid dealing with the issue of breast health. That's understandable. Just the thought of a breast lump can be terrifying. Yet there are a few simple steps you can take that could make a big difference in your breast health.

There are many myths and rumors about breast cancer. But here are three absolute facts.

Breast Self Examination
You might have heard that research studies do not show that women who practice BSE live longer if breast cancer is diagnosed.

But scientists do agree that finding a cancer when it's still small does offer the benefits of avoiding more complex surgery and possibly chemotherapy. So do take the time to learn this simple skill, and get in the habit of performing a BSE every month, starting at age 20.

The goal of breast self examination is not to identify every single lump—that could be a challenge, particularly for women whose breasts are lumpy. Instead, use BSE to become familiar with how your breasts feel normally, so that you can spot any changes early, and report them to your doctor. Think of BSE as BHA - breast health awareness.

LOOKING
Use a mirror wide enough to see not just the breasts, but the entire area where breast tissue can be found: from the collar bone to the bra line and from the armpit line to the breast bone. Check the shape and size of your breasts, and the color and texture of your skin, first with your arms down, then with your arms in the air. Two other positions—pushing down on the hips, to tighten your chest muscles, and bending forward at the waist, with your arms relaxed, will help you spot "dimpling"—the tugging on the skin or nipple, often caused by a growing tumor.

Look for changes in breast shape or size. It's not unusual for one breast to be larger than the other.

Check the skin for changes such as redness, a rash, or an orange-peel appearance.

Notice the nipples. Inverted nipples are normal, but a change in nipple appearance is not. Squeezing the nipple to check for discharge is no longer part of BSE. But if you have seen spotting on your bra from a spontaneous discharge, report it to your doctor. Lower your arms, and examine your armpits. Feel for pea-sized lumps that may be enlarged lymph nodes—a sign of a possible change within your breast tissue.

Place a folded towel under the shoulder and extend the arm out at an angle, to spread the breast tissue more evenly over your chest, for easier examination.

Women with larger breasts should roll to the side until the nipple points straight up, as if floating on top of the breast. This position helps the breast tissue lie evenly flat.

In the past, some women examined their breasts in the shower. This is no longer done. In the standing position, any breast bigger than an A-cup is difficult to examine thoroughly.

To feel the breast, use the pads of your fingers because they're more sensitive than the tips. Use the three middle fingers, keeping the thumb and pinkie out of the way. Make three dime-sized circles. One lightly. One deeper. One as deep as comfortable. This will enable you to check the full thickness of the breast.

Move your fingers over—about the width of two fingers—and circle again. With deep pressure you might even feel your ribs just behind your breasts.

When you move your hand, don't lift it away from the skin so you don't miss a spot. Instead, "walk" your fingers to the next spot. Keep the fingers straight, with the pads—not the tips—flat against the breast. Your fingers should be almost parallel to your breast.

Examine the entire area where breast tissue may be found. Start near the armpit. Go up and down in strips about as wide as your three fingers. Up to your collarbone and down to the bra line. Overlap the strips slightly so no area is left unexamined. Go all the way over to the breast bone. Change hands, and check the other breast. Again, starting from the armpit, up and down, all the way across to the breast bone.

Studies have shown that the "vertical strip" technique is more effective in covering the entire breast area than the circular or the wedge patterns.

If you had breast surgery or breast implants, use the same technique, and examine the entire breast area.

At first, many women are confused by the lumpiness they feel in their breasts. What would a tumor feel like if you found one? Some people say it feels like a marble in a sock, or a raisin under a napkin, or a peanut in a pack of gummi bears... It doesn't really matter. You are not trying to make a diagnosis. Your task is simply to spot a change—any change—in the normal look or feel of your breasts, and report it promptly.

Whether you find something by BSE or by accident, report it promptly to your doctor. That's what breast health awareness is all about.

Clinical Breast Examination
Clinical breast examination is done by a trained physician, nurse practitioner or other healthcare professional. The technique is the same that you use for your breast self examination—looking and feeling. The examiner will check the entire area where breast tissue may be found—from the clavicle to the bra line, and from the breast bone to the armpit line. Generally, the accuracy of the exam is proportional to the time spent. Depending on the size of your breasts, a complete exam may take 3-10 minutes.

Susan G. Komen for the Cure recommends that you have a clinical breast exam at least every 3 years beginning at age 20, and annually starting at age 40. If your healthcare provider doesn't perform a breast exam when it is due, ask for one!

Women who have a history of breast cancer should insist on a thorough examination, with particular attention to the incision line, or the scar line.

Mammography
Today, mammography, or breast x-rays, is considered to be the best method for finding breast cancer early. Only a small amount of radiation is used in a mammography examination and the benefits outweigh the radiation risk.

There are several things you can do to ensure that your mammography experience is the best it can be.

Make sure that the mammography facility is certified—which means that it meets the required quality standards for the mammography equipment they use, the people who work there, and the records they keep.

If your breasts are particularly sensitive, avoid scheduling the mammogram the week before your period.

Give the technologist all the information you can about any past problems with your breasts, breast surgery, any family history of breast cancer, and the date and name of the facility where you had your last mammogram. Comparing your old x rays with the new ones can help the radiologist spot new changes.

On the day of the exam, wear a top that can be easily removed because you will be asked to take off all your clothing above the waist. Do not use underarm talcum powder or deodorant because they may show up as false spot on the x-ray picture. Inform your technologist if there is any possibility that you are pregnant.

A mammogram takes only a few minutes. The technologist will need to place your breast on the digital detector or film holder. The pressure may be uncomfortable, but should not be painful, and it will last only a few seconds. Compression on the breast is extremely important, because the more you can eliminate overlapping tissue, the better and more accurate the mammogram will be—with less radiation dose. You can ask the technologist to stop at any time and reposition the breast.

For routine, or screening mammograms, only two pictures of each breast will be taken: top to bottom, and side to side. The same procedure will be repeated on the other breast.

Sometimes the technologist will get additional views. Don't be alarmed. Taking a few extra pictures doesn't mean that a problem was found. The additional views may be needed simply to examine a specific area, since breasts vary so much in tissue composition.

Before you leave, ask how and when your doctor will get the results of your mammogram. If you do not receive the results within ten days, call your doctor or the mammography facility.

Mammograms are read by a radiologist—a physician who has special training and experience in interpreting mammograms. An experienced radiologist, proper technique and state-of-the-art equipment can lead to early detection, and the best chances for successful treatment.

Who should have mammograms? Most experts now agree that women should have mammograms every year, beginning at the age of 40. If you have a mother or sister who had breast cancer before menopause, your doctor may recommend that you begin having regular mammograms earlier.

New (2007) recommendations by the American Cancer Society include MRI in addition to mammography for women at high risk for developing breast cancer.

Mammography is the most sensitive method for finding breast abnormalities. But it doesn't detect all of them. If you feel a lump, or any other change, have it checked by your doctor, even if your mammogram was normal. Early detection could be the key to peace of mind and a healthy life.

Other Imaging Modalities
In addition to mammography, other tests, such as ultrasound, may be used. Ultrasound uses harmless and painless sound waves that may help distinguish between different types of breast lumps. Ultrasound is particularly helpful in younger women, whose breasts are more dense, and more difficult to examine with mammograms.

MRI is also a useful tool in breast imaging. This technique uses a combination of magnetic and radio waves to obtain an extremely detailed picture of the breasts. MRIs are expensive, and are not a substitute for mammography, but they can be very effective in spotting subtle abnormalities such as leaking silicone implants, or tiny lesions.

Recently the American Cancer Society issued a recommendation that all women who are at very high risk for developing breast cancer should have an annual MRI in addition to the mammogram.