Breast self-examination (BSE): In about 80% of breast cancer cases, the woman detects the lump herself. Women are advised to examine their breasts on a monthly basis starting around age 20. Women may be able to detect early signs of cancer if they become proficient at BSE and familiar with the usual appearance and feel of their breasts. A study did find that women who perform regular breast self-exams might be more likely to undergo unnecessary biopsies after finding breast lumps. Breast self-examination should be performed once a month at the same time each month, one week after a woman's period.
Clinical breast exam (CBE): Unless there is a family history of cancer or other factors that place the individual at high risk, the American Cancer Society recommends having clinical breast exams once every three years until age 40. After that, the American Cancer Society recommends having a yearly CBE. During this exam, the doctor examines the breasts for lumps or other changes. He or she may be able to feel lumps missed by self-examination and will also look for enlarged lymph nodes in the armpit (axillary).
Mammography: Overall mammography is a very effective breast cancer screening tool, and has the ability to detect breast cancers before they can be felt by BSE or CBE. Images on mammograms appear in gradations of black, gray, and white depending on the density of the tissue. Bone shows up as white, fat appears dark gray, and cancerous tumors appear a lighter shade of gray or white. Unfortunately, dense normal breast tissue can also appear light gray on a mammogram, which can make mammograms harder to interpret in younger women, since they tend to have breast tissue that is denser. After menopause, though, breast density usually begins to decrease, making the mammograms of older women easier to read. For this reason, it is important to follow the guidelines for clinical breast examination (CBE) and to practice regular breast self-examination (BSE).
If a lump in the breast is found, either by breast self-exam or mammography, other tests will be performed in order to make a diagnosis. The only proven way to reduce the risk of dying from breast cancer is by having regular mammograms after the age of 50.
Computer-aided detection (CAD): Radiologists normally view X-rays and mammograms, and their skills and experience play a large part in determining the accuracy of the test results. In CAD, a computer scans the mammogram after a radiologist has reviewed it. CAD helps identify suspicious areas on the mammogram, although many of these areas may later prove to be normal. Using mammography and CAD together may increase the cancer detection rate.
Digital mammography: In this procedure, an electronic process is used to collect and display X-ray images on a computer screen. This allows the radiologist to alter contrast and darkness, making it easier to identify subtle differences in tissue. In addition, the images can be transmitted electronically, so women who live in remote areas can have their mammograms read by an expert who is based elsewhere.
Magnetic resonance imaging (MRI): Magnetic resonance imaging (MRI) uses a magnet linked to a computer to take pictures of the interior of the breast. Although not used for routine screening, MRIs can reveal tumors that are too small to detect through physical exams or are difficult to see on conventional mammograms. Some centers may use MRI as an additional screening tool for high-risk women who have dense breast tissue on a mammogram. MRIs aren't recommended for routine screening because they have a high rate of false-positive results, which lead to unnecessary anxiety and biopsies. They are also expensive and not readily available.
Ductal lavage: In a ductal lavage, the clinician inserts a tiny, flexible tube (catheter) into the lining of a duct in the breast and withdraws a sample of cells. The cells are then examined for precancerous changes that might eventually lead to disease. These changes show up long before tumors can be detected on a mammogram. Ductal lavage isn't recommended as a screening tool for high-risk women. It is a new procedure with risks, including the rate of false-negative results and its inability to determine the exact location of abnormal cells and whether they will lead to cancer.
Breast ultrasound (ultrasonography): A breast ultrasound is used to evaluate an abnormality seen on a mammogram or found during a clinical exam. Ultrasound uses sound waves to form images of structures deep within the body. Because an ultrasound does not use X-rays, ultrasound is a safe diagnostic tool that can help determine whether an area of concern is a cyst or solid tissue. Breast ultrasound is not used for routine screening because it has a high rate of false-positive results.
Molecular breast imaging (MBI): Molecular breast imaging (MBI) experimental technique tracks the movement of a radioactive isotope taken up by breast tissue. Images are taken of the breast when the radioactive isotope signals are detected. In preliminary studies, MBI found small tumors that both mammography and ultrasound missed. This procedure uses lighter compression, and may be more comfortable than mammography. The MBI takes about 40-50 minutes as opposed to 15 minutes for a mammogram, and the procedure is more invasive due to the injection. It is still unclear how abnormal findings are biopsied, and the studies remain ongoing.
Fine needle aspiration: During a fine needle aspiration, a thin needle is inserted into the lump and a sample is withdrawn. This test helps to determine if the lump is fluid-filled (a cyst, usually not cancerous) or a solid tumor. It can be performed in a doctor's office with local anesthesia. The sample, regardless of whether it is fluid or solid, is sent to the laboratory for further analysis.
During a core biopsy,
a larger needle is inserted into a lump or an abnormal area seen on a mammogram, and the tissue sample is removed. The sample is analyzed for cancer cells, and this procedure is usually performed at a hospital with local anesthesia.
Surgical biopsy: A surgical biopsy is when the lump and surrounding tissue is removed surgically before being sent to a laboratory for analysis. A surgical biopsy needs to be done in a hospital with either a local or general anesthetic.
Stereotactic biopsy: A stereotactic biopsy is used to sample and evaluate an area of concern that can be seen on a mammogram, but cannot be felt or seen on an ultrasound. During the procedure, a radiologist takes a core needle biopsy using the mammogram as a guide. Stereotactic biopsy usually takes about an hour and is performed using local anesthesia.
Wire localization: A doctor may recommend a wire localization when a worrisome lump is seen on a mammogram, but it cannot be felt or evaluated with a stereotactic biopsy. Using the mammogram as a guide, a thin wire is placed in the breast and is guided toward the lump. Wire localization is usually performed right before a surgical biopsy and is a way to help the surgeon find the area to be removed and tested.
Estrogen and progesterone receptor tests: If a biopsy reveals malignant cells, estrogen and progesterone receptor tests are usually performed on the malignant cells. These tests help determine whether female hormones affect the way the cancer grows. If the cancer cells have receptors for estrogen, progesterone, or both, the doctor may recommend treatment with a drug tamoxifen, which prevents estrogen from binding to these sites.
signs and symptoms
Common signs and symptoms of breast cancer include a lump in the breast that feels distinctly different from other breast tissue or that does not go away, swelling of the breast that does not go away, thickening of breast tissue, dimpling or pulling of the skin on the breast that resembles the skin of an orange, any change in the breast shape or contour, nipple discharge, retraction of the nipple, a scaly appearance of the nipple, pain or tenderness of the breast, swollen bumps, or puss-filled sores.
Fibrocystic changes: This condition can cause the breasts to feel ropy or granular. Fibrocystic changes are extremely common, occurring in at least half of all women. In most cases the changes are harmless. If the breasts are very lumpy, then performing a breast self-exam can be more challenging.
Cysts: These are fluid-filled sacs that frequently occur in the breasts of women ages 35-50. Cysts can range from very tiny to about the size of an egg. They can increase in size or become more tender just prior to menstruation and may disappear completely after. Cysts are less common in postmenopausal women due to the drop in hormonal levels.
Fibroadenomas: These are solid, noncancerous tumors that often occur in women during their reproductive years. A fibroadenoma is a firm, smooth, rubbery lump with a well-defined shape. It will move under the skin when touched, and is usually painless. Over time, fibroadenomas may grow larger or smaller or even disappear completely.
Infections: Breast infections (mastitis) are common in women who are breastfeeding or who have recently stopped breastfeeding, but mastitis may develop when women are not nursing. The breast will likely be red, warm, tender, and lumpy, and the lymph nodes under the arm may swell. The individual may also feel slightly ill and have a low-grade fever.
Trauma: Sometimes a blow to the breast or a bruise also can cause a lump in the breast tissue.
Calcium deposits (microcalcifications): These tiny deposits of calcium can appear anywhere in the breast and often show up on a mammogram. Most women have one or more areas of microcalcifications of various sizes. They may be caused by secretions from cells, cellular debris, inflammation, trauma, or prior radiation. Calcium deposits are not the result of taking calcium supplements. The majority of calcium deposits are harmless, but a small percentage may be precancerous or cancer.
Because breast conditions, such as fibrocystic changes, may make breast examination and mammography more difficult to interpret, early cancerous lesions may occasionally be overlooked.
Breast enlargement and reduction procedures:
Breast surgery (enlargement and reduction) has the same risk as any other type of major surgery, including bleeding, infection, and an adverse reaction to the anesthesia. Other possible risks specific to breast reduction surgery include: loss of sensation in the nipples and areola; impaired blood supply to the nipples, leading to nipple damage and scarring; inability to breastfeed; asymmetry in size, shape, position, and contour of the nipples or breasts, which may lead to further surgery to improve appearance; and altered body image and a period of adjustment to get used to the change in the individual's appearance.