Breast health

Breast health: early detection and screening of breast cancer

The key to effectively treating and hopefully preventing breast cancer is early detection and an awareness of warning signs and symptoms. Although the following are not necessarily indicative of breast cancer, they may nevertheless indicate other medical conditions. Be sure to check with your doctor if you exhibit any or all of the following signs.

Breast lumps

Breast lumps are usually felt during breast self-examination (BSE), although they are also sometimes detected by a screening mammogram or by a physician during a clinical breast examination (CBE) before it can be felt by a woman performing BSE. You should be particularly concerned if breast lumps are always present and do not appear or disappear with your menstrual cycle, if breast lumps feel like they are attached to the skin, or if they feel hard, irregular, and different from the rest of the breast tissue. Breast lumps may be tender but not necessarily painful. Where pain is present, it is more often a symptom of a benign condition, but it should nevertheless be discussed with your doctor.

Lumps in the axilla

Lumps in the axilla (area under the arm) are caused by swollen lymph nodes and usually indicate the lymphatic system is fighting an infection in the affected area. Such lumps may indicate that breast cancer has metastasized (spread) to the lymph nodes.

Inverted nipples

Some nipples are always inverted, but nipples that become inverted should be examined by a doctor.

Crusting or ulceration on the nipple

Crusting, ulceration, or eczema-type symptoms on the nipple may be indicative of Paget's disease, a rare form of breast cancer.

Discharge from the nipple

There are several different conditions that may cause discharge from the nipple; discharge from the nipple should always be reported to your doctor. If discharge occurs spontaneously and is blood stained, if may well be a sign of cancer and should therefore be discussed with your doctor.

Changes in the skin of the breast

Be sure to watch for changes in the skin such as:

• dimpling or puckering
• thickening or dimpling
• ridges
• wheals (round, itchy areas)
• distended veins in an irregular pattern
• redness, swelling, and increased warmth in the affected breast
• skin appearing to be attached to underlying breast tissue

These signs should further reinforce that breast health starts with knowing your own breasts. Becoming familiar with their texture, shape, and size will allow you to notice changes that may indicate problems. While most breast problems don't necessarily indicate cancer, they may be related to other conditions that require medical attention. In other words, any changes should be discussed with your doctor to learn their nature and whether treatment is needed. Breast cancer treatment and survival depends on early intervention: many women owe their survival to early detection and treatment of breast cancer. The sooner breast cancer is found, the greater the likelihood that treatment will be successful.¹

Screening tests for detection of breast cancer

Finding breast cancer depends on a number of reliable screening tests, including mammography and clinical breast examinations (CBE). The purpose of these screening tests is to find breast cancers before they begin to cause symptoms. In other words, these tests are often used detect disease in people who are asymptomatic. Early detection often results in earlier diagnosis of breast cancer that might have occurred. Breast cancers that are detected because of the presence of symptoms tend to be larger and are also more likely to have spread beyond the breast. By contrast, breast cancers detected during screening tests are more likely to be small and confined to the breast.²

Clinical breast examinations (CBE)

Regardless of their age, it's recommended that women have their breasts examined by a doctor or gynecologist at the very least once every two years. The American Cancer Society recommends clinical breast examinations at least every 3 years in women between 20 and 40, and annual CBE for women 40 and older. Such examinations may find lumps or tumors, including those that may not be found by mammography.³

Typically performed by a doctor, nurse practitioner, nurse, or doctor?s assistant, clinical breast examinations are performed for the purpose of noting any abnormalities in breast texture. During a CBE, the patient is undressed from the waist up, and the health professional uses the pads of the fingers to palpate the breast, gently feeling for any lumps. Particular attention will be paid to the shape and texture of the breasts, the location of any lumps, and whether such lumps are attached to the skin or to deeper tissues. The area under both arms will also be examined.⁴

CBE should provide instruction on how to become more familiar with the texture of your breasts; your doctor should show you how to effectively perform breast self-examination (BSE) and should also explain to you the benefits and limitations of both CBE and BSE. If you?ve been performing BSE, a clinical breast examination is a good opportunity for your health professional to review and offer feedback on your technique. He or she will also instruct you to promptly report any new breast symptoms.

Mammography

A mammogram is a diagnostic x-ray of the breast and is used to diagnose breast disease in women who display symptoms of breast problems, as well as a screening test in women who are asymptomatic. For more complete information on mammography, be sure to refer to Mammography, also in this section.⁵

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1. Early detection and Screening of Breast Cancer. Canadian Cancer Society. (2002-2004)
2. Can Breast Cancer Be Found Early? American Cancer Society. (2004)
3. Clinical Breast Examination. Canadian Cancer Society. (2002-2004)
   Can Breast Cancer Be Found Early? American Cancer Society. (2004)
4. Can Breast Cancer Be Found Early? American Cancer Society. (2004)
5. Can Breast Cancer Be Found Early? American Cancer Society. (2004)