Self Breast Exams
Look Around, Feel Around, Check Around
Screening Mammograms Saves Lives!
The death rate for breast cancer has decreased 2% per year since the invention of screening mammograms.3/4 of Women who do not make it to surviviorship are the ones who did not have yearly mammograms.The guidelines for screening mammograms recommend all women starting yearly mammograms at age 40. If you have been told you are high risk for developing breast cancer based upon your family history or abnormal changes in your breast seen on a biopsy, you may begin mammograms earlier than 40 and possibly more often than once a year.
Screening mamograms - are yearly exams that are given to women who do not have any breast symptoms or problems. There are two views 1) CC (cranial cuadal) - looks throught the breast from top to bottom. 2) MLO (mediolateral) - looks through the breast from the side. These views allow the mammographer to exam the entire breast.
Diagnostic mammograms - are exams that are needed when there is a problem or symptom in the breast. These exams may press the breast harder. They will place your breasts in different positions.Mammograms are read by mammographers who are radiologists who specialize in breast imaging. They use a scoring system call BIRADS (Breast Imaging Reporting and data system) to describe the findings. This is a score from 0-6. 0- incomplete need more tests, 1 - negative, 2 - benign or stable findings, 3 probably benign (there is a < 2% chance of cancer and the recommendation is for s short term follow up in 6 months0, 4 - suspicious finding (chance of cancer is between 3-94%) you will need a biopsy, 5 - highly suspicious (chance of cancer >94%) you will need a biopsy, 6 - known cancer (already biopsied).
Why do they have to squeeze the breasts for the exam? The mammogram is a type of xray. Your breasts are in between a camera and film plate where light has to travel through your breasts to captures images. The wider the distance the light has to travel the less detail we can see. We compress the breast to decrease the distance to capture more detail. This is a good thing. Most mammograms are digital now so less compresson is needed. 80% of centers have digital mammograms. Ask for a digital mammogram.
Mammograms can be done effectively in women with implants safely.Other diagnostic studies that are used when there is a symptoms or problem are:
Breast MRI - this test uses magnets not radiation, and radio waves to produce a 3D image of the breast. IV contrast dye will be used to help visualized cancerous tissue. Good for women recently diagnosed with cancer before surgery, women who are enrolled in high risk screening clinics who are high risk for cancer and women with young women with dense breasts. Most insurances will approve this test. MRI can lead to uncessary biopsies and increased anxiety.
Ultrasound - this test uses sound waves to look through the breast in layers. Not effected by dense breast tissue. The best test that can determine if a mass is solid or cystic. Used in minimially invasive biopsies to ensure the lesion was adequately sampled. This exams is technician dependent. It can not be used as a screening exam to see all of the breast tissue.Specific Gamma Imaging - is a test that does not require compression but looks at blood flow in the breast. This has not been shown to be better than mammogram in detecting cancer and is not standard of care.Tomosynthesis - takes multiple xray 3D pictures of the breast. Still uses the standard mammogram images. Still unknown if theis technology is bettern than digital mammorgrams. Not standard of care.
Yearly Breast Exams
At your routine doctor visit or annual PAP with the OB/GYN you should have a comprehensive breast exam by a doctor or nurse practitioner.He or she should be able to detect changes in your breast such as changes in breast size, skin texture, bruising, redness, nipple retraction, suspicious masses, which could signify anything concerning.Some women who are at high risk for developing cancer should have clinical breast exams every 6 months instead of yearly.Breast Cancer survivors should have clinical breast exams every 6 months for the first 5 years after surgery then yearly. These exams are important to check for evidence of local recurrence. Even women who have had a mastectomy are at risk for cancer coming back and will no longer have mammograms, will need comprehensive breast exams.