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The Importance of Breast Self-Exams

Monday, December 2nd, 2013

Breast cancer is a major topic of interest these days, partly because so many women will eventually get it, and partly because education can make such a huge difference in a given woman’s prognosis. According to the National Cancer Institute, the 5-year survival rate ranges from 98% when the cancer is caught early and has not metastasized to around 24% when it not found until after it has already spread to other parts of the body. This is precisely why screening measures such as breast self-exam, clinical exams by a doctor, and regular mammograms after age 40 are so important.

Breast Self-Exam

Self-exam is the most important and most effective screening method available to women younger than 40 years of age. It is free, takes very little time, and saves thousands of lives every year. No one is as familiar with your own unique breasts as you are, so you can often find changes, thickening, lumps, or skin changes that other people might not notice during an examination.

Examine your breasts during the same time each month – for example, ten days after your period starts. If that is too hard to keep track of, then do the exam on the last day of your period. Before or during your period is not a great time because your breasts may be enlarged, making it hard to determine what you are feeling.

Look at your breasts in the mirror, checking for symmetry. If one of your breasts has always been slightly larger than the other, then this is nothing to worry about. However, if one of your breasts has newly become larger than the other, this is something to get checked out. Look for any changes in the skin, such as dimpling, pitting (like an orange peel), or redness. Look for any retraction of the skin that occurs when you raise your arms above your head.

To feel for lumps or changes inside your breasts, the best place is in the shower because your hands slide more easily over wet, soapy skin. Use your fingers to make concentric circles all over your breast, working your way in toward the nipple, and checking for any unusual lumps and also squeezing the nipple to check for any discharge (there should be none unless you are lactating). Don’t forget to check your armpit for lumps as well. After your shower, repeat this exam lying on your back with your arm raised above your head and lotion or baby oil on your skin.

Why Is Breast Self-Exam Important?

In just a few minutes once a month, you could very well save your own life. Women have many reasons for not performing self-exams. They may be afraid of what they will find (ironically, breast self-exams keep women much safer). They may not think it necessary, since their doctors examine their breasts (but a tumor can do a lot of spreading in a year’s time). Or they may forget or not think about it for months at a time. However, the statistics show the importance of making an effort to remember this.

Clinical screening methods are also important and can catch things that a woman might not be able to feel or see in her own breasts. An annual exam by your gynecologist as well as regular mammograms are important screening tools that save many lives – but neither is as effective or as important as being familiar enough with your own breasts to be aware of a change the moment it happens. If you do feel or see a change in one of your breasts, but your doctor seems to think it’s nothing, don’t worry – he or she is probably right – but do insist on following up with a mammogram to take another look. No one knows your body like you do. You are the expert on your unique body, you are the one responsible for your own well-being, and you are the one in charge of watching for signs of breast cancer and getting medical attention immediately if they do appear.

If you are older than 40 years of age, then a mammogram is the preferred approach to evaluation of your breast (perhaps with an adjunctive sonogram for dense breasts).  A Canadian Task Force concluded that breast self-examination in older women (40-69 years) )should not be performed due to increased anxiety and unnecessary biopsies for benign disease.  However, as I have stated in my women’s health book, “Inside Information for Women”, I believe that breast self-examination has the potential to detect breast cancer that you can feel and still should be recommended.

– Yvonne S. Thornton, M. D., M. P. H.

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Researchers Suggesting There is No “One-Size-Fits-All” Approach to Breast Screenings

Monday, July 29th, 2013

Mammograms are universally accepted as the most effective way of screening for breast cancer; however, is this really true? Many women may be surprised to learn that there is more than one method for detecting potentially life-threatening masses in the breasts, and these varying procedures are being used in an increasing number of women in the population.  This is not to say that mammograms are not important or valuable as a detection tool in screening for breast cancers – however, in many cases it may not be effective when used alone, and as new screening technologies are developed and become more widespread an increasing number of women will need to work with their doctors to develop a more personalized approach to breast screenings.

According to a new report in the June issue of the American Journal of Medicine, for many years, mammography has been the sole imaging test recommended for breast cancer screening, and remains the only test proven to reduce breast cancer-related mortality. However, the widespread application of mammography in population-based screening remains controversial, owing to decreased sensitivity in women with dense breast tissue, radiation concerns, and a high rate of false-positive studies, leading to excessive breast biopsies.  Those who image the breasts are adapting to these challenges with the development of new technologies. Low-dose mammography can reduce radiation risk to the breast. Contrast-enhanced mammography can evaluate blood flow in the breast, similar to MRI. Tomosynthesis produces multiple mammographic slices through the breast, similar to computerized tomography (CT scan), and has significant potential to lower recall rates and increase specificity.

The article goes on to say that both whole-breast ultrasound and MRI have been shown to detect additional cancers in certain high-risk populations and will likely be increasingly used in screening women with dense breasts. MRI studies are very expensive and have a high false positive rate, i.e., they have difficulty in identifying a negative on the image as a true negative (without disease) in the patient.  However, a decrease in mortality has not been proven using these modalities.  Molecular imaging in the form of BSGI and PEM of the breast is widely available. Positron emission mammography (PEM) and breast-specific gamma imaging (BSGI) use molecular imaging to increase specificity in cancer detection by demonstrating increased metabolic activity.  However,  due to relatively large whole-body radiation doses (equivalent to 20-30 mammograms), they are not currently suitable for annual screening.

The reason that the same method will not work with every woman is because every woman’s body is different. Variations in the structure of a woman’s breast, the density of her breast tissue, or even the existence of implants may affect the ability of the standard mammogram to fully detect any underlying lumps or irregularities in her breast tissue. Simply put, every woman’s breasts are different, and so too must the screening for every woman be different.

While these advances are encouraging, it is improbable that any of the new technologies will replace mammography for population-based screening programs, because all have significant limitations.  Furthermore, given the heterogeneity of the human population, a “perfect” imaging technology for breast cancer screening will likely never be found.  However, women who feel as if they have different needs should consult with their doctor and ask whether or not there may be special considerations they should make as a part of screening for cancers. However, ultimately the main thing that older women should do is to continue receiving their mammograms regularly as well as younger women (less than 35 years of age) conducting breast self-examinations on a regular basis within the comfort of their own home. In coming years it is likely that the plan of action for women will begin to change depending on individual women’s needs, but the existence of different technologies is still no substitute for the screening methods that are commonly accepted and readily available.

– Yvonne S. Thornton, M. D., M. P. H.

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