Tessa Quinn
Breast cancer is one of the most common cancers affecting women worldwide. Breast cancer screening plays a critical role in empowering women to take control of their health by identifying potential risks before symptoms appear. Women are encouraged to be more aware of how their breasts normally look and feel, so it becomes easier to spot any suspicious changes. A breast self-examination (BSE) is a great way to detect breast cancer early. It is recommended that women aged 50 to 74 get a health screening or mammogram every two years. Women aged 40 and above are advised to undergo annual mammograms.
| Characteristics | Values |
|---|---|
| Self-examination | Women should be aware of how their breasts normally look and feel, so it's easier to spot any suspicious changes. Self-examination should be performed once a month, preferably 3-5 days after the period ends. |
| Clinical breast examination | Performed by a primary care physician or gynaecologist, who will evaluate the breast lump or mass. Doctors will detect unusual changes or lumps in the breast tissue using their hands. |
| Mammogram | An X-ray of the breast that can detect changes in the breast and small deposits of calcium. Mammograms are recommended for women above 50 regularly, every 1-2 years, and for women above 40 with a family history of breast cancer. |
| Ultrasound | Used to detect breast changes. |
| Biopsy | A test used to diagnose breast cancer. |
| Surgery | The first line of attack against breast cancer. The kind of surgery depends on the stage of the cancer, the "personality" of the cancer, and the patient's preferences. |
| Monoclonal antibodies | Used to treat breast cancer by targeting receptors on cancer cells. |
| Endocrine therapy | Beneficial for patients with oestrogen receptor (ER) positive diseases. |
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Breast self-examination (BSE)
Visual Inspection:
Start by standing in front of a mirror with your arms at your sides, shirtless. Observe your breasts for any changes in size, shape, colour, and symmetry. It's important to note that breasts usually aren't identical, so it's essential to understand what is normal for your body. Look for swelling, dimpling, or any changes in the outline of the skin. Pay attention to the nipples and examine them for changes in position, shape, or discharge.
Physical Examination:
For the physical examination, use your right hand to examine your left breast, and then switch for the right breast. With the pads of your three middle fingers, gently press on every part of the breast using light, medium, and then firm pressure. Feel for any lumps, thick spots, or other unusual changes. You can use a circular motion to ensure you cover the entire breast. Don't forget to examine the tissue near your armpit and squeeze the nipple gently to check for any discharge.
Lying Down Examination:
Additionally, you can perform a breast self-examination while lying down, which can be more convenient for larger breasts as the tissue spreads out, making it easier to examine. Place a pillow under your right shoulder and lie down with your right arm behind your head. Use your left hand to press down all over your right breast, feeling for any changes. Gently squeeze the nipple to check for discharge and feel for lumps in your armpit. Then, switch sides and repeat the process for your left breast.
Timing and Frequency:
It is recommended to perform BSE once a month, preferably 3 to 5 days after your period ends, at the same time each month. For post-menopausal women, choose a consistent day each month, such as the 1st or 15th.
While BSE is an essential tool for early detection and breast health awareness, it is important to note that it does not replace regular clinical breast exams, mammograms, or consultations with healthcare professionals. If you notice any unusual changes or are concerned, be sure to consult a doctor for further evaluation and guidance.
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Clinical breast examination
During a clinical breast examination, the doctor will feel for any lumps, bumps, thick spots, or other unusual changes in the breast tissue. They may also gently squeeze the nipples to check for any discharge. If a lump is discovered, the doctor will note its size, shape, texture, and mobility. Benign lumps often have a distinct feel to them and are usually soft, smooth, round, and movable. On the other hand, cancerous lumps tend to be hard, oddly shaped, and firmly attached within the breast. However, it is important to note that further diagnostic measures, such as mammograms or ultrasounds, are typically required to confirm the nature of the lump.
It is important to note that clinical breast examinations are not recommended as a routine screening method for average-risk women by organizations like the American Cancer Society and the United States Preventive Services Task Force. Instead, they emphasize the importance of regular mammograms for early detection in this population. However, for women at higher-than-average risk, clinical breast examinations can still be offered, along with counseling about risk and early detection.
While clinical breast examinations are an important tool for evaluating breast health, they should be complemented by other screening methods, such as mammograms, ultrasounds, and in some cases, breast MRIs, to ensure comprehensive assessment and early detection of breast cancer.
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Mammograms
A mammogram is a type of X-ray imaging used to detect changes in the breast, such as small deposits of calcium or microcalcifications, which could indicate ductal carcinoma in situ (DCIS) or early-stage cancer. Mammograms can detect breast cancer before it becomes physically noticeable, making it a valuable tool for early detection and improving treatment outcomes.
The US Preventive Services Task Force recommends that women aged 40 to 74 at average risk for breast cancer should undergo a mammogram every two years. Women over 40 with a family history of breast cancer are also encouraged to have regular mammograms. It is important to consult a doctor to determine the appropriate screening frequency and methods.
There are two main types of mammograms: screening mammography and diagnostic mammography. Screening mammography is used as a preventive measure to detect breast cancer early on, while diagnostic mammography is used to investigate specific concerns or abnormalities found during screening. Diagnostic mammograms take longer as they involve more X-ray images from multiple angles to provide a detailed view of the breast.
Modern advancements in mammogram technology, such as 3D mammograms or tomosynthesis, have improved accuracy in detecting breast cancer. However, it is important to note that mammograms may not always detect all cancers, and other imaging techniques like ultrasounds or breast MRIs may be recommended in conjunction with mammograms, especially for women with dense breast tissue.
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Biopsy
A breast biopsy is a procedure to remove a piece of breast tissue or tumour, known as a sample. This sample is then sent to a lab to be examined for cancer cells. A biopsy is the only definitive way to diagnose breast cancer.
There are several types of breast biopsies, which differ in their invasiveness and the amount of tissue they remove. The type of biopsy performed depends on the patient's specific case and what is acceptable to them.
Fine-needle aspiration (FNA) biopsy
A very thin, hollow needle attached to a syringe is used to extract a small amount of tissue or fluid from the suspicious area. This procedure is usually carried out by a radiologist.
Core needle biopsy
A core needle biopsy uses a larger hollow needle to sample breast changes felt by the doctor or seen on an ultrasound, mammogram, or MRI. This is often the preferred type of biopsy if breast cancer is suspected.
Surgical or open biopsy
In rare cases, surgery is required to remove all or part of the lump for testing. This is usually performed when the entire mass, including surrounding normal tissue, needs to be removed to ensure all cancer cells are extracted. This type of biopsy may also be done to check the lymph nodes under the arm for cancer spread.
Wire localization procedure
This procedure involves placing a thin wire in the breast to guide the biopsy. It may be done on the same day as the surgery.
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MRI
A breast MRI (Magnetic Resonance Imaging) is a test that produces very clear and detailed images of breast tissue. It is often used in addition to mammography and ultrasound to screen for, diagnose, and evaluate breast cancer and other abnormalities. MRI scans are particularly useful for women with dense breast tissue, those with breast implants, and younger women who may have denser breast tissue.
Before the scan, an IV line is placed in a vein in the patient's arm so that a contrast material, such as gadolinium, can be injected during the test. This contrast dye helps radiologists see normal and abnormal structures more clearly. It is important to inform the radiologist if you are pregnant or breastfeeding, as you cannot undergo an MRI with contrast if you are pregnant.
Breast MRIs are often recommended for women at high risk of breast cancer, including those with a strong family history, BRCA1 or BRCA2 gene mutations, dense breast tissue, or a history of chest radiation between the ages of 10 and 30. They can help detect small lesions that may be missed by mammography, determine the size and location of lesions, and identify the extent of cancer, including whether it has spread to the chest wall or the opposite breast.
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Frequently asked questions
Women who are 50 to 74 years old and are at average risk for breast cancer should get a health screening or mammogram every two years. Women who are 40 to 49 years old should talk to their doctor about when to start and how often to get a mammogram. Women aged 25 to 39 should get a clinical breast exam every 1 to 3 years.
A mammogram is an X-ray of the breast that can detect changes in the breast and small deposits of calcium, which may be an early sign of cancer.
Breast self-examination (BSE) is an essential part of breast health awareness and can help in the early detection of breast cancer. To perform a BSE, stand in front of a mirror with your arms at your sides and look for lumps, differences in size and shape, and swelling or dimpling of the skin. Repeat with your arms raised above your head. Then, use your right hand to examine your left breast, and vice versa, checking for thick spots, lumps, or other unusual changes. Gently squeeze each nipple to check for any unusual discharge, and feel for any lumps in your armpit. BSE should be performed once a month, preferably 3 to 5 days after your period ends.
Clinical breast exams are performed by healthcare professionals and are an essential part of early detection. Doctors will detect unusual changes or lumps in the breast tissue using their hands. Mammograms and ultrasounds may also be recommended to detect breast changes.
If something unusual is found during a screening, you may be referred to a breast clinic for further assessment. This may include additional imaging such as X-rays, scans, or a biopsy to make a definite diagnosis. Most people who are referred to a breast clinic do not have cancer, but it is important to go to your appointments for a full assessment.
