Breast Cancer

How To Do A Breast Self-exam

It takes practice to perform a thorough breast self-examination. Ask your health professional for tips that can help you perform a breast self-examination correctly.

The best time to examine your breasts is usually one week after your menstrual period begins, when your breast tissue is least likely to be swollen or tender. If your menstrual cycle is irregular, or if you have stopped menstruating due to menopause or the removal of your uterus (hysterectomy), do your examination on a day of the month that’s easy to remember. Women who are pregnant or breast-feeding can continue to examine their breasts every month. Breast-feeding mothers can examine their breasts after a feeding or after using a breast pump so that the breasts have as little milk as possible, making the examination easier and more comfortable.

To do a breast self-examination, remove all your clothes above the waist and lie down. The examination is done while lying down so your breast tissue spreads evenly over your chest wall and is as thin as possible, making it much easier to feel all your breast tissue.

Use the pads of the three middle fingers of your left hand—not your fingertips—to check your right breast. Move your fingers slowly in small coin-sized circles.
Use three different levels of pressure to feel of all your breast tissue. Light pressure is needed to feel the tissue close to the skin surface. Medium pressure is used to feel a little deeper, and firm pressure is used to feel your tissue close to your breastbone and ribs. A firm ridge in the lower curve of each breast is normal. Use each pressure level to feel your breast tissue before moving on to the next spot.

Check your entire breast using a lengthwise strip pattern. Feel all of the tissue from the collarbone to the bra line and from the armpit to the breastbone. Start in the armpit and work down to the bottom of the bra line. Move one finger-width toward the middle and work up to the collarbone.

Repeat until you have covered the entire breast. Repeat this procedure for your left breast. See an illustration of BSE using a lengthwise strip pattern. The American Cancer Society prefers this method of breast self-examination because it is the best method for finding breast lumps.

You also can examine your breasts using a spiral pattern. Again, use three different levels of pressure to examine all your breast tissue. Avoid lifting your fingers away from the skin as you feel for lumps, unusual thicknesses, or changes of any kind. See an illustration of BSE using a spiral pattern. Most breast tissue has some lumps or thick tissue. When in doubt about a particular lump, check your other breast. If you find the same kind of lump in the same area on the other breast, both breasts are probably normal. Pay attention to any lump that feels much harder than the rest of your breast.

If you find anything that concerns you, schedule a visit with your health professional. The important thing is to learn what is normal for you and to report any changes to your health professional.
Remember that most changes you find are not breast cancer but should be checked. These changes may include:
Any new lump. It may or may not be painful to touch.
Unusual thick areas.
Sticky or bloody discharge from your nipples.
Any changes in the skin of your breasts or nipples, such as puckering or dimpling.
An unusual increase in the size of one breast.
One breast unusually lower than the other.

In addition to examining your breasts while lying down, you may also check them while in the shower. Soapy fingers slide easily across the breast and may increase your chances of detecting a change. While standing in a shower, place one arm over your head and lightly soap your breast on that side. Then, using the flat surface of your fingers—not the fingertips—gently move your hand over your breast (in the strip pattern described above), feeling carefully for any lumps or thickened areas.

What A Breast Mri Feels Like And How It Work

Magnetic resonance imaging (MRI) creates detailed images of your breast using a computer and powerful magnets. The procedure is used to follow up on worrisome symptoms or an inconclusive mammogram or ultrasound—though not always, because MRI is so expensive. MRI offers a very detailed picture of breast tissue, but it can also turn up a lot of false positives—suspicious results that prove, later, not to be cancer. High-risk women (with BRCA-1 or BRCA-2 gene mutations and/or a strong family breast cancer history) are often encouraged to get MRIs.

The procedure
MRIs are conducted with your body stretched out on a flat surface inside a metal tube. “You lie facedown and let your breasts hang through these huge holes,” recalls Kim Heier, 42, of Simi Valley, Calif. The hollows in the table contain coils for picking up the MRI’s magnetic signal. You may be given an injection of a dye that makes the mass in your breast easier to see.

Once the machine gets going, the buzzing, clicking, and thumping noises and the tight space can be nerve-wracking for some. Earplugs or headphones may be offered, and for people who are claustrophobic, taking a sedative drug beforehand might be an option.

On the other hand, some people find it appealing that there’s nothing to do but wait. “Being the mother of three children, I don’t get to sit down much, so lying in this machine for 30 minutes was kind of a relief,” recalls Heier. “[Occasionally, they] reminded me not to move and I was thinking, ‘No problem, I’m half asleep.'”

If you have cancer already
If you’ve been diagnosed with breast cancer in one breast, don’t be surprised if your doctor suggests an MRI for your other breast. A 2007 study by the American College of Radiology Imaging Network found that for women who’d been diagnosed with cancer in one breast, MRI scans picked up more than 90% of cancers in the opposite (aka contralateral) breast that had been missed by mammography and a clinical breast exam at initial diagnosis.

5 Simple Things That Could Cut Your Breast Cancer Risk

1. Limit yourself to two or three alcoholic drinks a week

Alcohol, consumed even in small amounts, is believed to increase the risk of breast cancer. Most doctors recommend cutting back on wine, beer, and hard liquor.

A recent study showed the link between drinking and breast cancer was especially strong in the 70% of tumors known as hormone-sensitive.

By Lorie Parch

2. Exercise at least three times a week (more often is even better)
And when you do exercise, work to keep your heart rate above its baseline level for a minimum of 20 continuous minutes. Long walks are nice too, but it\’s the more vigorous exercise (expect to sweat!) that really helps your heart and cuts your cancer risk.

3. Maintain your body weight, or lose weight if you\’re overweight

Research shows that being overweight or obese (especially if you\’re past menopause) increases your risk, especially if you put on the weight as an adult. And a study released in March 2008 by researchers at the University of Texas M.D. Anderson Cancer Center in Houston showed that obese and overweight women also had lower breast cancer survival rates and a greater chance of more aggressive disease than average-weight or underweight women.

4. Do a monthly breast self-exam

Be sure to get proper instruction from your doctor and have your technique reviewed regularly. You might catch a lump before a mammogram does, and it\’s a good idea to follow changes in your body.

5. Have a mammogram once a year after 40

Catching a tumor early boosts the chance of survival significantly: The five-year survival rate can be as high as 98% for the earliest stage localized disease, but hovers around 27% for distant-stage, or metastatic, disease.

What To Expect If You’re Having An Open Breast Biopsy

An open biopsy is done by a general surgeon, gynecologist, or family medicine doctor. The biopsy may be done in a surgery clinic or the hospital.

You will need to take off all or most of your clothes above the waist. You will be given a gown to use during the biopsy. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

An open biopsy can be done using local or general anesthesia. If local anesthesia is used, you may also be given a sedative.

If you have general anesthesia, an intravenous (IV) line will be put in your arm to give you medications. You will not be awake during the biopsy.

After the breast is numb (or you are unconscious), your doctor makes a cut through the skin and into the breast tissue to the lump. If a probe was placed using mammogram to mark the biopsy site, your doctor will take a biopsy from the area at the tip of the probe.

Stitches are used to close the skin, and a bandage is put on. You will be taken to a recovery room until you are fully awake. You can usually return to your normal activities the next day.

An open biopsy takes about 60 minutes.

What’s A Clinical Breast Exam ?

A clinical breast exam (CBE) is a hands-on examination of both breasts that every ob-gyn or family doctor should provide during a woman’s annual visit for a pelvic exam and Pap smear. The American Cancer Society recommends that women in their 20s and 30s have a CBE every three years; women 40 and older need one every year.

This can be especially useful for young women with dense breasts, says Janet Wolter, MD, a medical oncologist and the Brian Piccolo chair of Breast Cancer Research at Rush University Medical Center in Chicago, because their home breast self-exams (BSEs) are trickier to interpret.

“Older women have soft, easy-to-examine breasts. Once you’re menopausal, a lot of glandular tissue is replaced with fat and it’s easier to feel.”

Here’s what a CBE involves: Your doctor presses his or her fingers around each breast and into your armpits, checking for lumps as well as rashes, dimpling, or other abnormal skin changes. The doctor may gently squeeze each nipple to check for discharge.

No matter what your age, be sure to mention any changes you’ve noticed in your breasts to your physician during your visit, or call to discuss changes if you’re in between appointments.

Having A Breast Biopsy ?

Biopsies are the most conclusive test for telling whether you have cancer, and if so, what type. A doctor administers local or general anesthesia and then removes a sample of the suspicious lump, whether it’s a few cells, some tissue, or the entire lump. Pathologists examine the sample.

There are a few different kinds of biopsies used to help diagnose breast cancer: fine needle, core needle, stereotactic, and excisional.

Because biopsies are usually—though not always—the last step in your diagnosis, both the procedure itself and getting your results can be very stressful, but keep in mind that 80% of biopsy results come back benign.

“The whole process is nerve-racking—it’s a lot of hurry-up-and-wait and anxiety-provoking things,” says Mehra Golshan, MD, a breast surgical oncologist at the Brigham and Women’s Hospital and Dana-Farber Cancer Institute in Boston. “What happens is that something abnormal is seen and you have to hurry up and schedule a biopsy. It’s angst-provoking. Some women will need a small sedative before the procedure. Coming in with a friend or significant other usually helps a lot.” Says Kerry Apicella, 62, who had a core needle biopsy, “I can see where some people would freak out. It’s uncomfortable, and the minute they tell you not to move, of course, you feel you’ve got to move.”

Robin Hershkowitz, program director for women’s cancers at CancerCare, a national nonprofit support-services group based in New York City, suggests asking the doctor or technician to talk you through the test. “Usually it reduces your anxiety if someone says, ‘This is what will happen for a minute and a half, and then this happens.’ You can prepare for that,” she says.

3 Ways To Spot Breast Cancer

Early detection of breast cancer is key (and the closest thing to prevention we have), because a tumor is a lot easier to treat if you, your doctor, or a mammogram can catch it while it’s still small.

Screenings are for when you have no symptoms of disease but want to be sure something isn’t lurking that you haven’t spotted yet, says Peter M. Jokich, MD, director of the Rush Breast Imaging Center at Rush University Medical Center in Chicago.

Women who don’t have any breast cancer symptoms should consider committing to three kinds of routine screenings:

1. breast self-exams at home
2. clinical breast exams and, each year after you turn 40,
3. mammograms—this is the one that shouldn’t be skipped, experts say.

Other breast cancer tests—diagnostic mammograms, ultrasounds, MRIs, and biopsies—are for women with symptoms who, for example, “feel a lump, have redness on the skin of their breast, or have discharge from the nipple,” says Dr. Jokich.

What To Expect If You’re Having A Fine Needle Aspiration Breast Biopsy

A fine-needle aspiration biopsy may be done by an internist, family medicine doctor, radiologist, or a general surgeon. The biopsy may be done in your doctor’s office, a clinic, or the hospital.

You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

Your doctor will numb your skin with a shot of numbing medicine where the biopsy needle will be inserted. Once the area is numb, a needle is put through your skin into your breast tissue. Ultrasound may be used to guide the placement of the needle during the biopsy. If the lump is a cyst, the needle will take out fluid and tissue samples. If the lump is solid, a sample of tissue is taken. The biopsy sample is sent to a lab to be looked at under a microscope. You must lie still while the biopsy is done. The needle is then removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on. A fine-needle aspiration biopsy takes about 5 to 15 minutes.

How To Watch For Breast Cancer Symptoms

False alarms are especially common for women with fibrocystic breasts. (RICK GOMEZ/CORBIS/VEER) Being vigilant about changes in your breasts can help you spot the symptoms of breast cancer—and spot them earlier, when the cancer is more likely to be treated successfully.

While most doctors recommend monthly breast self-exams, it’s not yet clear if the practice results in higher survival rates overall. But women do sometimes find lumps on their own.

See your doctor if you notice anything at all.

Before you panic, however, keep in mind that most breast changes and lumps don’t end up being cancer—even if you get to the point of doing a biopsy. Nearly 80% of biopsies come back benign. False alarms are especially common for women with fibrocystic changes, which can make the breasts feel thicker or lumpy, with symptoms that may change over the course of the menstrual cycle. In the meantime, your best course of action is to follow a screening regimen that includes regular mammograms, clinical breast exams, and breast self-exams. Lead writer: Lorie Parch

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