- Understanding the Risk
- The average woman has a one-in-eight chance of having breast cancer during her lifetime. Several factors, however, can increase your risk:
- Family history. Your risk doubles if your mother or sister has had breast cancer. It is even higher if they developed breast cancer before menopause.
- Premalignant cells on biopsy. Women who have had a previous breast biopsy that was benign but showed certain suspicious cells are at increased risk.
Age
Two-thirds of all breast cancers occur in women over 50. As you grow older, your risk increases. The American Cancer Society recommends that women start having mammograms every 1 to 2 years at age 40. After age 50, the ACS recommends women have a mammogram once each year.
After looking at research from around the world on the potential benefits and harms of mammography for women younger than age 50, the National Cancer Institute concluded that there is no clear overall benefit and also no clear overall harm to using this screening test for women under the age of 50.
Whether or not you decide to have a mammogram at this time, it's important to remember that regular breast self-exams and clinical breast exams by your doctor are wise practices to follow for early detection of breast cancer.
The Breast self-exam (BSE)
There is some disagreement in the medical community about the effectiveness of BSE. Some believe BSE is not very accurate and can create needless anxiety and expense. This is especially true for younger women who have no special risk factors. However, those who say there is not enough evidence in favor of monthly BSE do not advise women who already do a self-exam to stop.
Performing a Breast Self-Exam
Despite the disagreement about breast self-exams, many health professionals strongly recommend that women perform monthly breast self-examinations (BSE) to increase their chances for early detection.
American Cancer Society recommends monthly BSE for all women age 19 and older. The procedure is actually quite simple and takes only about 5 minutes a month.
The best time to do BSE is 1 week after the start of your period. If you have already passed through menopause, do BSE on the first day of each month. If you've had a hysterectomy, ask your doctor to advise you on the best time for you to perform BSE.
- What to Look For
- It's normal for women's breasts to feel lumpy, to swell, or to become tender, especially around the time of menstruation. By performing BSE each month, you will become familiar with the feel, shape, and size of your breasts, making it easier for you to notice changes should they occur. Here are some things to look for while examining your breasts:
- New lumps or changes in the size or shape of existing lumps
- Change in the shape or contour of your breasts or unusual swelling
- Changes in skin color or texture
- Dimpling, puckering, crusting, or rash in the skin, especially around the nipple
- Any fluid leaking from the nipple
Remember that even if you have some of these signs, it doesn't necessarily mean you have breast cancer. Most breast lumps are not cancerous. You should call your doctor if you notice any lumps or changes that concern you. He or she can tell you if you should schedule an appointment.
They also suggest that women who have not had breast cancer detected may stop mammography screening at age 75.
Screening for Breast Cancer
Your breasts are always changing. They change during the menstrual cycle, pregnancy, breastfeeding, and menopause (when menstrual periods end). Along with these normal changes, problems can arise. Most of the problems are minor, but a few can be serious. One serious problem, breast cancer, remains a leading cause of death in women.
Screening tests are used to find a health problem early. If they are done regularly, they may detect a problem even before symptoms are seen or felt. There are three screenings for breast problems that you or your doctor can do: mammography, a breast self-exam , and a doctor's examination of the breasts. For the best results, all three should be done regularly. If any one of these tests shows a problem-even if the other results are normal-it should be checked out.
Mammography
Mammography is a way to detect changes in the breast tissue by X-ray. It is useful for finding tiny lumps before they can be felt. The test is more useful in women over 40. Older women's breasts are less dense, so it is easier to detect lumps. Also, breast cancer is more likely to occur as a woman gets older. Some women feel slight discomfort during mammography. If you still menstruate, you may find that having your exam right after your period is more comfortable.
Tests
If you have found a lump in your breast or the results of your mammography are not normal, other tests may be used to help diagnose breast problems. Sometimes, these tests are done by your doctor. Other times, you will be referred elsewhere. These tests are done in addition to the history and breast.
Ultrasound
In ultrasound, sound waves are used to create pictures of the inside of some body organs or tissues, like the breast. This painless method can tell your doctor about certain types of breast lumps. These pictures can show whether the lumps are solid or filled with fluid, such as with a cyst. They are not, however, accurate enough to be used alone for screening.
Needle Aspiration Biopsy
Sometimes, when a cyst is suspected, fluid or tissue is with drawn through a needle for study. This is called needle aspiration. If the fluid is clear and the cyst disappears, no more tests will probably be needed. Aspiration can also be used to drain a cyst. Ultrasound may be used to help guide the needle. The sample may be sent to a lab to be checked.
Treatment
Benign breast disease often goes away on its own over time. If not, it often can be treated with drugs or minor surgery. The treatment of breast cancer depends a great deal on what type of cells there are, the size and location of the tumor, and how much the cancer may have spread. Most initial treatments include either removal of the lump (lumpectomy) plus radiation treatment (with Xrays), or complete removal of the breast and the Iymph nodes in the armpit (modified radical mastectomy). Treatment with either limited surgery and radiation or modified radical mastectomy is now standard for breast cancer in early stages. Radical mastectomy, in which the chest muscles are also removed, is rarely done.
Source: Patient education material from the American College of Obstetrics and Gynecology was used as a source of information to develop the content for this topic.
