Attention to Breast Health

I remember instructing a patient on how to do a self-breast exam. She called me the following week, so proud to have taken an initiative in her own health care. “Doctor,” she exclaimed. “I am so glad you taught me how to do that exam. I found 10 breast cancers!”

By nature, breast tissue is very lumpy, some more than others. No wonder many women fail to examine their breast each month either from fear of finding something or thinking they really don’t understand what they are looking for.

To compound matters, in 2009, the U.S. Preventive Services Task Force (USPSTF) revised the mammogram guidelines. They suggested screening mammograms should start at the age of 50, be done every two years instead of annually and gave no recommendations for women 75 and older. They also suggested doctors should not teach women to do breast self-exams.

However, a large study in Sweden looked at over 1 million women in their 40s who received screening mammograms. They found a 30% decrease in death from breast cancer and we know detected early, there are better treatment options and more successful outcomes for this disease.

In addition, many authorities did not agree with these recommendations including the American Cancer Society, the Mayo Clinic and many practicing clinicians. They still recommend a screening mammogram starting at age 40 and then annually.

Also the concept of breast awareness has developed and may give some purpose to self-breast exams. By doing these monthly exams, usually right after your cycle or in menopausal women a day easy to remember like the first of each month, women can become familiar with their own breast tissue. This allows them be more perceptive of changes or abnormalities that may develop, detect potential problems early and alert their health provider. A study looked at women who underwent breast cancer surgery. They found 40 percent of these breast cancers were found during self-breast exams even though these women also had frequent screening mammograms.

The self-breast exams can be done standing or lying. You can ask your provider during an exam to show you how to do the exam too and multiple sources are available on the Internet.

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Concerning findings on a breast self-exam that may alert you to contact your provider are:

A breast lump or thickness that feels different from surrounding breast tissue
Bloody nipple discharge
Change in the size or shape of the breast
Changes in the skin over the breast, like dimpling
Inverted nipple
Peeling, scaling or flaking of the nipple or breast skin
Redness or pitting of the skin over your breast, like the skin of an orange

A mammogram, a special type of x-ray, can detect breast cancer early. Screening mammograms are done when the woman has no symptoms of breast cancer and diagnostic mammograms, which take longer because more pictures are taken, are for women with symptoms. Abnormalities are found in 6% to 8% percent of women who have screening mammograms. If an abnormality is found, additional views are usually suggested or a breast ultrasound to see if the area of concern is a cyst that contains fluid or a solid mass.

There are several types of mammograms available:

Film mammography: Black and white X-ray images are taken and recorded directly on film.
Digital mammogram: X-ray images are recorded on a computer, instead of directly on film.
3-D mammography: Allows visualization of the breast and additional views through and around structures not seen with traditional 2-D views. However, they may use more radiation at greater cost compared with traditional mammograms. FDA approved but limited access and not yet recommended by many of the major women’s cancer groups.

Breast cancer affects one in eight women. The majority of cases are not related to family history or risk factors. However, most of us know a friend or relative diagnosed with, suffering from or unfortunately has succumbed to breast cancer. Those who carry the breast cancer related gene, BRCA 1 or BRCA 2 may develop the disease eight years earlier than their affected relatives. Also there still seems to be race disparity with breast cancer being more lethal for black women. The Federal Office for Minority Health finds that although black women are 10% less likely than white women to be diagnosed with breast cancer, they are 1.5 times more likely to die from it and their five-year relative survival rate was 10% to 15% less.

It is up to you to take an active role in staying healthy. Get the information you need to reduce your risk of breast cancer.