BREAST CANCER

 Cont.

Breast Self-Exam (BSE)
Breasts come in all shapes and sizes just as
women do. Breast self-exam is intended to
help you learn what is normal for you. BSE
is done once a month so that you become
familiar with the usual appearance and feel
of your own breasts. Familiarity makes it
easier to notice any changes in your breasts
from month to month. Early discovery of
a change is the whole idea behind BSE.
If you discover anything unusual, such as
a lump, discharge from the nipple, or
dimpling or puckering of the skin, you should
see your doctor at once. Remember, eight out
of 10 breast lumps are not cancer.

The human breasts are paired subcutaneous
organs composed of glandular breast tissue,
fat, and fibrous tissue.

As an endocrine target organ, breasts are
sensitive to monthly hormonal changes.
Before menstruation, estrogen and
progesterone increase the size of the
glandular tissue, the vascularity and the
amount of water in the breast, making good
breast examinations difficult. All of these
changes regress after menstruation.

The ideal time for a breast examination is
two to three days after the end of your
menstrual period, when the breast achieves
its minimal volume, and true changes
are easier to detect. A woman who no
longer has periods may find it helpful to
pick a particular day, such as the first of
the month, to remind herself that it is time
to do BSE.

Breast Lumps
Women frequently consult their doctors
about suspected breast lumps. In women
under 40, breast lumps are usually benign.
Most lesions seen at this age are "fibroadenomas"
(smooth, round masses with a clearly defined edge),
"cysts" (round, mobile, often tender masses
that may appear suddenly), or simply
"prominent breast tissue" (common in younger
women with a small amount of breast fat,
which makes the glandular tissue easily palpable).
Fibroadenomas occur twice as often in
African-American women as in others.

If a breast lump is detected on physical examination,
a small needle may be inserted into the lump to
determine if it is solid or cystic. If it is solid,
removal under local anesthesia on an out-patient
basis is all that is indicated. Removal is
recommended because the mass will not
disappear but will grow slowly, and confirming
the lump is benign provides peace of mind to
the patient. If aspiration with a needle reveals
a greenish-bluish fluid, this most likely is a
benign cyst. If the mass turns out to be cystic
and completely disappears, careful follow-up,
often including a mammogram (especially if
the patient is over 40), is all that is indicated.
These cysts may be multiple and may reappear in the future.

Breast lumps in women over 50 always are
considered potentially malignant until proven otherwise.

Mammography
Mammography allows physicians to detect
small and early changes that may be
suspicious. It can detect breast cancer up
to two years before you or your doctor
can feel a lump. Mammography is an X-ray
of the breast from the top (craniocaudal view)
and the side (lateral view). The amount of
radiation from a mammogram is very small.

Women under age 40 should discuss the
role of screening mammography with their
doctors, taking into account family history
and other risk factors.

Mammography in younger women is less accurate.
It usually reveals only dense breast tissue
that may mask an underlying tumor.

Mammography is more accurate in women
over 50 whose glandular breast tissue has
become atrophic. As women age, glandular
tissue disappears, becomes atrophic and is replaced by fat.

It is recommended that women over age 40
request a mammogram every one to two years.
Comparison between successive mammograms
is necessary. If you have had a mammogram
done elsewhere, it is helpful to bring it with
you when a new one is ordered. If an
abnormality is seen on the mammogram,
you may require further evaluation and biopsy.

Two-thirds of women do not follow recommended
guidelines for mammography. It is estimated
that cancer deaths would decline in women
over age 50 by at least 35 percent if women
got mammograms as recommended. 







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