Mammography

Types of Breast Exams

It's important to remember that every woman should consider herself at risk for breast cancer. A woman's best tool in fighting this disease is knowledge of her body through clinical breast exams and mammograms, her family history and other risk factors.

Mammogram

A mammogram is an X-ray of the breast. Mammograms are useful in two ways. They can be used to screen for breast disease, and they can be used to help diagnose a condition when a lump is found or a tumor is suspected. Mammograms can detect cancers that are much smaller than those that can be found by clinical breast exams or by breast self-exams. This provides a big advantage, because the earlier a breast tumor is discovered, the better the chances are of treating it successfully.

Mammograms and breast implants

A woman who has breast implants should continue to have mammograms. (A woman who has an implant following breast cancer surgery should ask her doctor whether a mammogram is still necessary.) The woman, however, should inform the technologist and radiologist beforehand to make sure they are experienced in X-raying patients with breast implants.

Mammograms are not perfect

Mammograms have limitations. Because they are very sensitive, they may show that a tumor exists when there actually isn't one; this is called a false positive. X-rays don't penetrate dense tissue very well. So a tumor in dense, glandular tissue may go undetected; this is called a false negative.

False negative mammograms

A normal mammogram in a woman with symptoms does not rule out breast cancer. Breasts of younger women contain many glands and ligaments and appear dense on mammograms. This makes it difficult to see lumps or to distinguish between normal and abnormal breast conditions. As a woman grows older, the breast tissue becomes less dense, and mammograms can see into the breast tissue more easily. About 25 percent of breast tumors are missed in women in their 40s, compared with about 10 percent of women older than 50. Sometimes a clinical breast exam by a doctor or nurse can reveal a breast lump that is missed by a mammogram.

False positive mammograms

Between 5 and 10 percent of mammogram results are abnormal and require further testing. This can mean more mammograms, fine needle aspiration, ultrasound or biopsy. Most of these follow-up tests indicate a false positive mammogram and confirm that no cancer was present.

Ultrasound

Ultrasound uses high-frequency sound waves that penetrate the breast and produce an image that can be viewed by a technician. Ultrasound is painless and harmless. This test is especially useful in screening the dense breasts of young women. Ultrasound, unlike mammograms, can be used to distinguish between solid tumors and fluid-filled cysts.

CT scanning

Computed tomography, or CT scanning, uses a computer to organize and stack the information from multiple X-ray views of a body's organ or area. A CT can be helpful in locating breast abnormalities that are difficult to pinpoint with mammography or ultrasound.

Clinical breast exam

Most professional medical organizations recommend that a woman have periodic breast exams by a health care provider. For most women, a breast exam should be a routine part of a health exam.

Your health care provider will look at your breasts in different positions and will check your breasts carefully for changes in the skin, discharge from the nipples or difference in size and shape between the two breasts. The next step is palpation. Using the pads of the fingers to feel for lumps, your provider will inspect the entire breast and underarm, first on one side, then on the other.

A lump is generally the size of a pea before a skilled examiner can detect it.

Breast self-exams

The value of a breast self-exam (BSE) is not endorsed by all professional organizations. The American Cancer Society still recommends BSE although not with the same fervor as previous years. The National Cancer Institute and the U.S. Preventive Services Task Force don't recommend for or against BSE, concluding that BSE does not result in increased survival and that it does result in increased procedures such as biopsy for benign lesions. But most health care providers recommend that you examine your breasts regularly every month. This helps you get familiar with the way they usually look and feel, and then it's easier to notice any changes from one month to the next. Finding such changes is the main reason for doing self-exams.

If you still have a period, the best time to do a self-exam is one week after your period ends. That's when your breasts are least likely to be tender or swollen. If you no longer have a period, pick a day, such as the first day of the month. Remind yourself to do a self-exam on that day every month. Here is a list of steps to take when doing your self-breast exam.

How to Do a Self-Exam

Breast self-exam, a physical exam of the breast done by the woman herself. Some training is required for a woman to know she is doing the exam correctly and to learn what to look for.

1. Stand before a mirror. Inspect both breasts for anything unusual, like any discharge from the nipples, and any puckering, dimpling or scaling of the skin.
2. This step and the next one will help you notice any change in the shape or contour of your breasts. First, watching closely in the mirror, clasp your hands behind your head and press your hands forward. You should feel your chest muscles tighten. Look for irregularities in the shape of your breasts.
3. Next, press your hands firmly on your hips and bow slightly toward the mirror. Pull your shoulders and elbows forward and watch closely in the mirror. Again, make sure your chest muscles tighten, and look for irregularities in the shape of your breasts. Some women do steps 4 and 5 in the shower. If you let your fingers glide over wet, soapy skin, it may be easier to notice the texture of the tissue underneath.
4. First, raise your left arm. Use three or four fingers of your right hand to explore your left breast firmly, carefully and thoroughly. Beginning at the outer edge, press the flat part of your fingers in small circles, moving the circles slowly around the breast. Gradually work toward the nipple. Be sure to cover the entire breast. Pay special attention to the area between the breast and the armpit, including the armpit itself. Feel for any unusual lump or mass under the skin.
5. Next, gently squeeze the nipple and look for a discharge. Repeat the exam on your right breast, using your left hand. (If you have any discharge during the month-whether or not it's during a self-exam-inform your health care provider.)

Steps 4 and 5 should be repeated lying down. Lie flat on your back, left arm over your head and a pillow or folded towel under your left shoulder. This position flattens the breast and makes it easier to examine. Use the same circular motion described earlier. Switch arms and repeat on your right breast.