The Facts about Breast Cancer Detection

Breast cancer is the most common form of cancer among American women. Three-fourths of the cases of breast cancer occur in women ages 50 or older, but it affects younger women, too - and about 1,400 men a year.

More cases of breast cancer are being diagnosed, but no one knows all the reasons why. Some of the increase can be traced to better ways of recognizing and detecting cancers at an early stage. The increase also may be the result of changes in the way we live - postponing childbirth, taking contraceptives and replacement hormones, eating high-fat foods or drinking more alcohol.

The encouraging news is that, more and more, breast cancer is being detected early, while the tumor is very small and limited to the breast. Two-thirds of newly diagnosed breast cancers show no signs that the cancer has spread beyond the breast, and most women diagnosed with early stage breast cancer are candidates for treatment that saves the breast.

The key to finding breast cancer is early detection, and the key to early detection is a regular screening mammogram (an x-ray of the breast) along with a clinical breast exam by a doctor or nurse.

Mammography
Mammography is a simple procedure. It uses an x-ray machine specifically designed for use only on breasts. The doses of radiation used for mammography are very low and considered safe.

The standard screening exam includes two views of each breast, one from above and one from the side. A registered technologist positions the breast between two flat plastic plates, which are then pressed together. The idea is to flatten the breast as much as possible; spreading the tissue out makes any abnormal details easier to spot with a minimum of radiation.

Although the pressure from the plates may be uncomfortable, it helps to remember that each x-ray takes less than one minute, and it could save your life. It also helps to schedule mammography just after your period, when your breasts are least likely to be tender, or at the same time each year, if you no longer have your period.

The mammogram is first checked by the technologist and then read by a diagnostic radiologist, a doctor who specializes in interpreting x-rays. The radiologist looks for unusual shadows, masses, distortions, dense areas, and differences between the two breasts.

The shape of a mass can be important, too. A benign (non-cancerous) growth, such as a cyst, looks smooth and round and has a clearly defined edge. Breast cancer, in contrast, often has an irregular outline with finger-like extensions.

Risk Factors
One or more of the following conditions place a woman at higher than average risk for breast cancer:

• personal history of a prior breast cancer
• mother, sister, daughter, or two or more close relatives, such as cousins, with a history of breast cancer (especially if diagnosed at a young age)
• a diagnosis of a breast condition that may predispose a woman to breast cancer (such as atypical hyperplasia), or a history of two or more breast biopsies for benign breast disease
• evidence of a specific genetic change that increases susceptibility to breast cancer

Risk factors do not by themselves cause cancer, and having one or more does not mean that you are certain or even likely to develop breast cancer. Even among women with no other risk factors except a strong family history - for example, both a mother and a sister or two sisters with early-onset breast cancer - three-fourths will not develop the disease. On the other hand, not having any of the known risk factors does not mean that you are "safe." Most women who develop breast cancer do not have a strong family history of breast cancer or fall into any special higher risk category.

A woman who has had breast implants should continue to have mammograms; she should inform the technologist and radiologist beforehand and make sure they are experienced in x-raying patients with breast implants.

Most states now have laws requiring health insurance companies to reimburse all or part of the cost of screening mammograms; check with your insurance company. Medicare pays some of the cost for screening mammograms; check with your health care provider or call the Medicare Hotline (1-800-638-6833) for details.

Your mammograms are an important part of your health history. Being able to compare earlier mammograms with new ones helps your doctor evaluate areas that look suspicious. If you move, ask your radiologist for your films and hand-carry them to your new physician, so they can be kept with your file. Always make sure that the radiologist who reads your mammogram has the old films to use for comparison.

The effectiveness of mammography seems to increase as a woman ages. The older you are, the greater your chance of getting breast cancer. No woman should consider herself too old to need regular screening mammograms.

Mammography is not foolproof, and some breast changes do not show up on a mammogram. But a lump should never be ignored just because it is not visible on a mammogram. Changes can be especially difficult to spot in the dense, glandular breasts of younger women. This is why women of all ages should have a clinical breast exam every year by a physician or trained health professional.

Clinical Breast Exam
Most professional medical organizations recommend that a woman have periodic breast exams by a doctor or nurse along with getting regular screening mammograms. You may find it convenient to schedule a breast exam during your routine physical.

The examiner will look at your breasts while you are sitting and while you are lying down. You may be asked to raise your arms over your head or let them hang by your sides, or to press your hands against your hips. The examiner checks your breasts carefully for changes in the skin such as dimpling, scaling or puckering; any discharge from the nipples; or any difference in appearance between the two breasts, including differences in size or shape. Next, using the pads of the fingers to feel for lumps, the examiner will systematically inspect the entire breast, the underarm, and the collarbone area, first on one side, then on the other.

A lump is generally the size of a pea before a skilled examiner can detect it. Lumps that are soft, round, and smooth tend not to be cancerous. An irregular, hard lump that feels firmly anchored within the breast tissue is more likely to be a cancer. However, these are general observations, not hard and fast rules. The only sure way to know if a solid lump is cancer is to have some tissue removed and examined under the microscope.

Currently, mammography and breast exams by the doctor or nurse are the most common and useful techniques for finding breast cancer early. Other methods such as ultrasound may be helpful in clarifying the diagnosis for women who have suspicious breast changes. However, no other procedure has yet proven to be more effective than mammography for screening women with no symptoms.

If You Find a Lump
If you find a lump or other change in your breast, don't try to diagnose it yourself. There is no substitute for a doctor's evaluation. If you discover a lump in one breast, check the other breast. If both breasts feel the same, the lumpiness is probably normal. You should, however, mention it to your doctor at your next visit.

But if the lump is something new or unusual and does not go away after your next menstrual period, it is time to call your doctor. The same is true if you discover a discharge from the nipple or skin changes such as dimpling or puckering. If you do not have a doctor, your local medical society may be able to help you find one in your area.

You should not let fear delay you. It is natural to be concerned if you find a lump in your breast. But remember that four-fifths of all breast lumps are not cancer. The sooner any problem is diagnosed, the sooner you can have it treated.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.