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Early Detection of Breast Cancer: The Breast Self Exam

It is common knowledge that the earlier a cancer is found the better chance for survival. It is no different with breast cancer. The largest risk factor is being female and aging. So, what's a woman to do? Mortality has decreased significantly with the use of screening. Screening means looking for a disease when an individual is completely without symptoms, as opposed to "diagnostic" testing done wot evaluate symptoms like breast pain or a breast lump, or to further investigate something new or a change in the breast seen on your routine mammogram. Current recommendations for screening are baseline mammography at age 35 and yearly from age 40 on. Unfortunately, there is no perfect x-ray! Breast imaging is pretty darn good, but it can miss up to 15% of all breast cancers.

What about breast self exam? Anyone who has ever felt their breasts knows that there are plenty of "lumpy-bumpy" areas. Breast tissue changes in response to hormones and since it extends into the armpits, so can tenderness. Deciding whether an area is abnormal can be a dilemma. In my opinion, the best time to do your breast exam is after your menstrual cycle is finished. Breast are primarily symmetrical, so one side should feel like the other side. Comparing the sides of each breast can help determine if there is an abnormality. If doing a breast self exam just causes too much anxiety, at least look at your breasts in the mirror occasionally, Raise your arms looking for retraction (pulling in of skin) around the nipple. Glance inside your bra to look for staining and at the nipple itself checking for crusting. "Drainage" depending on age, number of ducts involved, and medicines can even be "physiologic" or normal. Do not compress the nipples since overzealous compression can cause bleeding. Drainage that is bloody, clear, or only from one duct can be more serious and needs further evaluation. Women may not feel comfortable doing breast self exam but as we age, our risk increases, so try to be observant.

Without coordination with breast imaging, breast self exam alone may not necessarily save lives. As a matter of fact, there was a recent suggestion in a local newspaper that perhaps breast self exam should be done away with completely. I strongly disagree. Of course, a breast exam should be part of your yearly physical exam done by your family physician or gynecologist. Bottom line - you are your own best advocate so if something doesn't feel "quite right" seek help from a medical professional Because of its variability it can be difficult to know if what you feel is really abnormal. It might take a few visits and some imaging to be certain, so follow through with a repeat exam if things do not seem to be resolving. Common sense should prevail. You can't run away - your breasts go with you! Early detection can save lives. The breast self exam is simply one of the first steps in that direction.

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