Breast Self Exams (BSE), Clinical Breast Exams (CBE), and Mammograms are the three most commonly encouraged screenings for breast cancer. Screenings are used to find tumors in individuals at their earliest stages, while they are small and confined to one area of the breast. The earlier the tumors are found, the better the outcomes for survival.
In 2009, an individual task force released some recommendations for breast cancer screenings. This controversial information was discussed by many experts, in addition to, the Health and Human Services Secretary (HHS) Kathleen Sebelius. To read information regarding their recommendations for breast cancer screenings, click on the National Cancer Institute link below: http://www.cancer.gov/ncicancerbulletin/111709/page2 or HHS Secretary Kathleen Sebelius at: http://www.hhs.gov/news/press/2009pres/11/20091118a.html
American Cancer Society and National Cancer Institute Recommendations (2010):
- Women, starting in their 20’s (late teens), should become familiar with their breasts by performing Breast Self Exams (BSE).
- Women in their 20s and 30s are encouraged to have a periodic Clinical Breast Exam (CBE), by a health professional, at least every 3 years.
- Women younger than age 40, but have a higher than average risk of breast cancer should talk with their health care providers about whether to have mammograms and how often to have them (NCI, 2010).
- Women age 40 and older are encouraged to have a yearly mammogram.
- Women age 40 and older should have a CBE yearly, as a compliment to their mammograms.
- Women who are at high risk (known BRCA 1 or BRCA 2 gene mutation, first degree relative with breast cancer, high risk assessment of developing breast cancer – based mainly on family history, radiation therapy to the chest when they were between the ages of 10 and 30 years old, and have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes) should have a yearly MRI with their mammograms.
BREAST SELF EXAMINATIONS (BSE):
A Breast Self Examination (BSE) involves seeking changes and lumps in the breast and surrounding areas. BSEs are beneficial in providing women with knowledge about how their breasts feel (textures) and look (size, marks). A monthly BSE allow many women to detect abnormalities in their own breast, including detecting lumps, which may not be discovered by mammography alone. The discovery of any symptoms should not be assumed to be breast cancer, but a woman should seek a doctor’s consultation immediately.
It is best not to examine your breasts during your menstrual cycle, when breasts are often swollen or tender. It is suggested that you choose one week after your menstrual cycle to perform your examination, when breast are no longer swollen. If you no longer have menstrual cycles, choose one day of the month (like your birthday or anniversary) and use that day to perform your examinations each month for continuity. ACS recommends that you demonstrate your techniques for performing your breast self exam with your health care provider. For a visual instruction on performing BSE, visit http://breastselfexam.ca/ .
|Benefits of BSE||Limitations of BSE|
|Doing the exam regularly allows you to know how your breasts look and feel. You will also be able to readily detect any signs or symptoms if a change occurs, such as the development of a lump or swelling, itching, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, or a discharge other than breast milk.||Sometimes, women are so concerned about “doing it right” that they become stressed over the technique.|
|The procedure is quick and free.||Many women become unnecessarily anxious and worried when they find a possible breast change (before confirming the diagnosis with their health care provider).|
|No help is needed in performing the exam.||Some scientific evidence that BSE alone does not lower the overall death rates from breast cancer.|
|Many women find their own lumps or breast changes before they are diagnosed by a health care provider.|
CLINICAL BREAST EXAMINATIONS (CBE):
Women are encouraged to obtain a CBE as part of their breast health starting in their 20s. CBEs are conducted by a medical professional and are similar to the BSE performed by an individual. The CBE is an extensive examination where the patient sits or lies down while the examiner looks for skin dimpling and scaling in the breast area, puckering, changes in the appearance around the nipple, abnormalities in the underarm area, and differences in the shape of each breast. With the palms of their fingers, the health provider also performs deep tissue palpitations, seeking to discover any lumps in the breast or underarm areas. If lumps are identified, the provider will determine if the lumps are superficial or in the deeper tissues. Women are encouraged to use this examination to ask questions of their providers about BSE and review their techniques in performing a BSE for accuracy.
[box title=”Free Mamograms” color=”#fdd3f2″]The Centers for Disease Control and Prevention provides information regarding free or low cost mammograms available around the U.S. at: http://apps.nccd.cdc.gov/cancercontacts/nbccedp/contacts.asp[/box]
Mammography is one of the most effective ways of detecting abnormal masses or tumors, even when the woman does not have noticeable symptoms. The x-ray is able to detect tumors that are too small to be felt (NCI, 1998) and, when detected, provides information about size and location that physicians use in determining the stage of the cancer. The mammogram takes about a total of 20 minutes and involves your breasts being pressed between 2 plates for several seconds to flatten and spread the tissue. Some women complain of discomfort, but flattening the tissues helps the provider get a clear picture of any breast masses. Most women receive 2 x-ray pictures, per breasts. However, women with implants will generally receive more pictures because the implants can hide abnormal tumors. All digital images from a mammogram are interpreted by a radiologist to determine your breast cancer diagnosis and any further recommendations.
If your insurance company does not pay for mammograms, you may contact ACS at 1-800-227-2345 for information about finding low cost mammograms in your area. [table style=”3″]
|Benefits of Mammograms||Limitations of Mammograms|
|Can detect tumors in women who are asymptomatic, when the tumors are generally small and confined to one area.||Mammograms can miss some types of breast cancers, therefore, creating a false negative.|
|The x-rays of your breasts can be used yearly to compare and identify any breast changes.||High cost for test, some insurance companies may not cover the cost of a mammogram unless you are recommended by a physician.|
|Several large studies worldwide have shown breast cancer screening with mammograms reduces the number of deaths from breast cancer for women ages 40 to 69, especially for those over age 50.||A mammogram alone cannot prove that a mass is cancerous. A fine needle biopsy is generally performed to confirm if the mass is a benign or malignant tumor.|
|Breast implants make it harder to see breast tissue on standard mammograms, but additional x-ray pictures with implant displacement and compression views can be used to more completely examine the breast tissue.|
|They do not work as well in younger women, usually because their breasts are dense, and can hide a tumor.|
|This can be problematic for young women who are at high risk for breast cancer (due to gene mutations, a strong family history of breast cancer, or other factors) because they often develop breast cancer at a younger age.|
|Mammograms are used to find breast cancer that cannot be felt. If you have a breast lump, you should have it checked by your doctor and consider having it biopsied even if your mammogram result is normal.|
Many women complain of temporary pain from the squeezing of the breasts during the exam. It usually lasts a few days. For more information on screenings, visit the American Cancer Society website at: http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-detection