Am Fam Physician. 2000;62(3):605-606
See related article on breast cancer.
What are the warning signs of breast cancer?
Breast cancer is one of the most common cancers in women. Women more than 20 years of age should know the signs of breast cancer and the best ways to find it early.
These warning signs of breast cancer should be reported to your doctor:
Any new lump in the breast
A dimple (puckering) in the skin or a change in color
Change in the size or shape of the breast
A nipple that becomes inverted (pulled in)
A discharge from the nipple, especially if the fluid comes out by itself or is bloody
How do I perform a breast self-exam?
Begin by standing in front of a mirror. Look at your breasts with your hands above your head, with your arms down at your side and your chest muscles flexed. Look for any changes in the skin or size of your breasts. Next, feel each breast while standing in the shower. Raise one arm and use soapy fingers of the other hand to feel your breasts. Use your fingertips to feel all of the breast tissue and the areas under your arms (armpits). After your shower, feel each breast while lying down on a bed with a pillow under your shoulder. One arm should be raised over your head, and the other arm should reach across to feel the entire breast.
Finding a change in your breast can be scary, but most breast changes are not cancer. Many women have painful swelling in their breasts at the time of their menstrual periods. It is important to do your breast self-exam a few days after the end of your period when this swelling has gone away.
The most important way to find breast cancer early is to get regular mammograms. A mammogram is a breast x-ray. It can find cancers when they are very small. The amount of radiation used in the x-ray is very small and doesn't greatly increase your risk of getting breast cancer. The risk of missing a breast cancer is much higher if you don't have regular screening mammograms.
Mammograms can find cancer up to two years before you would be able to feel a lump. Your breasts are squeezed between compression plates. This is uncomfortable only for a few seconds. If your breasts hurt at the time of your periods, have your mammogram done two weeks before your period starts—it won't hurt so much. Sometimes close-up views are necessary. Benign (harmless) lumps can often be found by a combination of mammogram, ultrasound exam and physical exam. If a lump is very likely benign, your doctor may want you to have a follow-up mammogram or ultrasound exam in six months.
After menopause, mammograms may be less uncomfortable. Women taking hormone replacement therapy should have mammograms done after their period of bleeding if they are taking cyclic hormone therapy.
When should I have my mammogram?
The American Cancer Society and the National Cancer Institute recommend that all women start getting mammograms every year at age 40. The U.S. Preventive Services Task Force says only women between 50 and 65 years of age should have mammograms. The best age to start getting regular mammograms depends on your risk of breast cancer. The risk is different for each woman. Ask your physician what is the best age for you.
Clinical Breast Exam
You should have your breasts examined regularly by your doctor or another health care professional. Not all cancers are seen on mammograms. Remember to tell your doctor about any areas that worry you or any breast symptoms you may have noticed. Ask your doctor when it's time for your breasts to be checked.
Sometimes an ultrasound exam may be used to complete breast screening. An ultrasound exam can tell if a lump is solid or filled with fluid.
A biopsy is the only way to know for sure that a lump is not cancer. In a biopsy, your doctor removes a tiny bit of tissue from the lump and looks at it under a microscope. Biopsies can be done with a needle in the doctor's office. If the lump can't be felt, a needle biopsy can be done in the radiology department, using a mammogram or ultrasound to show the doctor where to put the needle. This is done using local anesthesia. Sometimes it is necessary to take out the entire lump. This is done as outpatient surgery.
Benign breast lumps
The most common breast lumps are fibroadenomas and cysts. They are benign (harmless) lumps. Fibroadenomas are smooth and round. They are most often found in younger women. A cyst is a fluid-filled sac that often gets bigger and then smaller during the menstrual cycle.
What is the best way to screen myself for breast cancer?
Perform monthly breast self-exams.
Have a physical breast exam by a doctor every three years for women 20 to 39 years of age, then every year after age 40.
Get an annual mammogram starting at 40 to 50 years of age.