Breast Cancer Screening

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Breast Cancer Screening

Screening is a systematic evaluation of a 'normal' individual to see if there is any underlying disease. Screening for breast cancer implies that a person with no signs or symptoms or having a suspicious or doubtful symptom or who is ‘at risk’ for cancer is evaluated for cancer.

This is required for all women but more so for those at high risk, who need screening more often. By the time a breast lump can be felt, it would have reached a few centimetres and a minimum of stage 2 cancer or more. As the size of the tumour increases, the chances of it spreading increases and survival decreases.

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By screening, the aim is to detect the cancer even before it can be felt, so that the outcome is good.

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The National Comprehensive Cancer Network (NCCN) recommends screening as follows:

  1. Women at normal risk, 20-40 years of age
    • Clinical breast examination: every 1 to 3 years
    • Breast self-examination every month
  2. Women at normal risk, over 40 years of age
    • Annual clinical breast examination by a qualified and trained doctor
    • Annual mammography for those in the age group 40-50 years and every 2 years for those above 50 years
    • Breast self-examination every month
  3. Women with high risk of breast cancer
    • Annual clinical breast examination by a qualified and trained doctor
    • Breast self-examination every month
    • Annual mammography:
      • For women who have received radiation therapy to the chest, a mammogram should be done annually from the age of 25 years.
      • For women with a family history of breast or ovarian cancer, annual mammogram should start by 35 years of age or earlier depending on the age of the primary case.
      • For women with proven genetic susceptibility to breast or ovarian cancers or those with first or second degree relatives with breast or ovarian cancers, an annual mammogram should start around 25 years of age.
  4. MRI of the breast: In the above high risk group , an annual MRI is also recommended as an adjunct to mammogram.

What is clinical breast examination?

This is a visit to a breast clinic with a trained and qualified breast doctor, who will:

  • Evaluate the patient’s history for any evidence of breast cancer and also to categorise the risk of breast cancer
  • Perform a general check up
  • Perform a breast examination to detect any abnormality

The aim is to detect any cancer early or allay the fears of any cancer, clinically.

What is breast self-examination?

Breast self-examination is a systematic examination of the breast, at regular intervals, aimed to familiarise a woman with her breasts and to be able to detect any irregularity or lump in the breast, nipple, skin or armpit. A woman should learn the right technique of examining her own breasts to detect any lump (cancerous or not). It is best done every month just after a menstrual period, during bath.

When breast self-examination is done, it aims to look for any abnormality in the breasts and not just for cancers.

The procedure

Your doctor will teach you how to do this.

Step 1: Look at your breasts while you stand in front of a mirror, with chest exposed, with arms by your side. Look for any irregularities, contour, dimpling, rash, redness of the nipple or breast skin, retraction of nipples, discharge from nipples, change in size and shape from earlier appearance.

Then raise your arms over your head and examine as above.

Then press your hands on your waist, press inwards and tighten your chest muscles and examine as above. Turn from side to side and look for any changes. Place your hands on the waist and bend forward and look for any changes in breast shape.

With your arms by your side, check the armpit with the other hand, for any lumps or thickening.

Any changes, however minor should be reported to your doctor.

Step 2: Lie down and place a pillow under your right shoulder and right arm behind your head. Use the finger pads of the middle three fingers (not the tips) of the left hand to feel for lumps in the right breast. Use overlapping circular motions of the finger pads to feel every inch of the breast tissue.

Use light pressure to feel the tissue closest to the skin, medium pressure to feel a little deeper and firm pressure to feel the tissue closest to the ribs and chest.

Use an up and down pattern starting at your underarm and move slowly to the middle of the chest bone. Be sure to check the entire breast, going below your breast till you feel the ribs and up till you feel the collar bone.

Repeat the examination on the left breast.

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See your doctor if you notice any of the following:

  • Lump, hard knot or thickening in the breast
  • Change in size or shape of the breast
  • Dimpling or puckering of the skin
  • Rash or redness of the nipple or breast skin
  • Blood-stained nipple discharge
  • New breast pain that does not go away
  • Recent retraction of the nipple
  • Hard knot in the underarm