Types of  Breast Exams

It's important to remember that every woman should consider herself at risk for breast cancer. A woman's best tool in fighting this disease is knowledge of her body through clinical breast exams and mammograms, her family history, and other risk factors.

Mammogram

A mammogram is an X-ray of the breast. Mammograms are useful in two ways. They can be used to screen for breast disease, and they can be used to help diagnose a condition when a lump is found or a tumor is suspected. Mammograms can detect cancers that are much smaller than those that can be found by clinical breast exams or by breast self-exams. This provides a big advantage, because the earlier a breast tumor is discovered, the better the chances are of treating it successfully.

Mammograms and breast implants

A woman who has breast implants should continue to have mammograms. (A woman who has an implant following breast cancer surgery should ask her doctor whether a mammogram is still necessary.) The woman, however, should inform the technologist and radiologist beforehand to make sure they are experienced in X-raying patients with breast implants.

Mammograms are not perfect

Mammograms have limitations. Because they are very sensitive, they may show that a tumor exists when there actually isn't one; this is called a false positive. X-rays don't penetrate dense tissue very well. So a tumor in dense, glandular tissue may go undetected; this is called a false negative.

False negative mammograms

A normal mammogram in a woman with symptoms does not rule out breast cancer. Breasts of younger women contain many glands and ligaments and appear dense on mammograms. This makes it difficult to see lumps or to distinguish between normal and abnormal breast conditions. As a woman grows older, the breast tissue becomes less dense, and mammograms can see into the breast tissue more easily. Sometimes a clinical breast exam by a doctor or nurse can reveal a breast lump that is missed by a mammogram.

False positive mammograms

Between 5 and 10 percent of mammogram results are abnormal and require further testing. This can mean more mammograms, fine needle aspiration, ultrasound, or biopsy. Most of these follow-up tests indicate a false positive mammogram and confirm that no cancer was present.

Ultrasound

Ultrasound uses high-frequency sound waves that penetrate the breast and produce an image that can be viewed by a technician. Ultrasound is painless and harmless. This test is especially useful in screening the dense breasts of young women. Ultrasound, unlike mammograms, can be used to distinguish between solid tumors and fluid-filled cysts.

CT scanning

Computed tomography, or CT scanning, uses a computer to organize and stack the information from multiple X-ray views of a body's organ or area. A CT can be helpful in locating breast abnormalities that are difficult to pinpoint with mammography or ultrasound.

Clinical breast exam

The American Cancer Society (ACS) recommends clinical breast exams (CBEs) at least every three years for all women in their 20s and 30s. The ACS recommends annual CBEs for women ages 40 and older. The U.S. Preventive Services Task Force (USPSTF), however, believes there is not enough evidence to assess the value of CBEs for women ages 40 and older. Women should talk with their doctors about their personal risk factors and make a decision about whether they should have a CBE.

If you have a CBE, your health care provider will look at your breasts in different positions and will check your breasts carefully for changes in the skin, discharge from the nipples, or difference in size and shape between the two breasts. The next step is palpation. Using the pads of the fingers to feel for lumps, your provider will inspect the entire breast and underarm, first on one side, then on the other.

A lump is generally the size of a pea before a skilled examiner can detect it.

Breast self-exams

The USPSTF does not recommend breast self-exams (BSEs) because evidence suggests BSEs do not lower risk for death from breast cancer. The ACS says BSEs are an option for women 20 and older as a means of familiarizing themselves with their breasts so they can notice changes more easily. Talking with your doctor about the benefits and limitations can help you decide if you should start performing BSEs.

If you still have a period, the best time to do a BSE is one week after your period ends. That's when your breasts are least likely to be tender or swollen. If you no longer have a period, pick a day, such as the first day of the month. Remind yourself to do a self-exam on that day every month. Here is a list of steps to take when doing your BSE.