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Active Living
Full Listing with story descriptions
A Healthy Balance
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Active Kids, Healthy Kids
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Children, Nutrition & Exercise
Beat the Heat!
Cold Weather Workouts
Concussions
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Exercise is Medicine
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FITT Prescription
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From Surviving to Thriving
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Live Actively
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Prehistoric Workout
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7 Wonders of Walking
Adolescent Health
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A Woman's Physical
Your First Job
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Childbirth
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Advice from the Maternity Clinic
Advice from the Maternity Clinic (Part 2)
Alcohol in Pregnancy
Building a Better Baby
Birthing Etiquette
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Birthing Procedure Trends
Bleeding in Pregnancy
Breastfeeding Benefits
Caesarean Section by Request
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Cord Blood Banking
Delaying Motherhood
Blue after Baby or Postpartum Depression
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Folic Acid in Pregnancy
High Blood Pressure in Pregnancy
Getting a latch on breastfeeding
Group B Streptococcus
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Low Birth Weight Babies
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Prenatal Classes
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Postpartum Repetitive Strain Injuries
RH Disease
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Sex During Pregnancy
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Smoking and Pregnancy
Support During Labour
Travelling While Pregnant
Ultrasound for Fun & Photos
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When Baby Comes Home
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Not Just Baby Fat
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Full Listing with story descriptions
Introduction
Managing Your Pain
Movement Matters
Moving Forward
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Prevention
Returning to Work
Understanding and Goal Setting
When Pain Doesn't End
Dental Health
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Antibiotics and Dental Surgery
Baby Bottle Tooth Decay
Baby Teeth
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A Healthy Mouth
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Seniors Oral Care
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The Smile You Want
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Snoring and Sleep Apnea
Smiling through the Senior Years
Teeth for Life
Temporomandibular Disorders (TMD)
Tobacco Risks to Oral Health
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Water Fluoridation
Wisdom Teeth
Your Healthy Smile
DIABETES
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10,000 Steps
A1C Test
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Alchohol and Diabetes
A Diabetes Success Story
ABCs of Diabetes Management
Alternate Site Testing
Artery Health
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Benefits of Insulin
Benefits of Breakfast
Blood Glucose Medications
Blood Glucose Myths
Blood Glucose Testing
Blood Glucose Testing Tips
Blood Sugar Lows
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C-Peptide Testing
Canada Food Guide Revisited
Carbohydrate Counting
Catastrophic Drug Plan
CDA Guidelines for Diabetes
Celiac Disease and Diabetes
Celebrating Health
Childhood Diagnosis of Diabetes
Children and Type 2 Diabetes
Cholesterol-lowering Medications
Colds and Diabetes
Constipation
Continuous Blood Glucose Monitoring
Cutting Edge
Dangers of Uncontrolled High Blood Pressure
Debunking Diabetes Myths
Driving and Diabetes
Diabetes and Menopause
Diabetes and OTC Medications
Diabetes Care Team
Diabetes and Celiac
Diabetes and Depression
Diabetes Diet
Diabetes Distress
Diabetes Eating on a Shoestring Budget
Diabetes Etiquette
Diabetes and Oral Health
Diabetes and Thyroid Disease
Diabetes and Your Mouth
Diabetes and Your Eyes
Diabetes in Cats
Diabetes in Dogs
Diabetes Management ABCs
Diabetes Meter Technicians
Diabetes Myths
Diabetic Ketoacidosis
Diabetic Retinopathy
Diet Tips for South Asians
Dining Out
Drinking and Diabetes
The Discovery of Insulin
Eating Disorders
Easing the Strain of Stress
Eating to Protect Your Kidneys
Eating Well During Shift Work
Eggs in a Diabetic Diet
Emotional Eating
Emotions of Diabetes Diagnosis
Erectile Dysfunction
Exercise Excuses
Why Fad Diets Fail
Fats
Fibre
Fill Your Day with Energy
Financial Support for Diabetes
Food Temptation
Foot Care
Footwear and Foot Health
Fruits and Veggies
Gastroparesis
Gestational Diabetes
Get Active
Get Physical
Gift Ideas
Glucose Meters
Glycemic Index and Glycemic Loads
The Glycemic Index
Going Green in the Kitchen
Grocery Shopping Tips
Guidelines for Diabetes Management
Holiday Party Survival Guide
Health Information on the 'Net
Healthy Happy Holidays
Healthy Beverage Choices
Health Benefits of Soy
Healthy Restaurant Meals
High Blood Pressure and Diabetes
High Blood Pressure
HbA1c Test
Healthy Eating for Active People
High Blood Lipids
Home from the Hospital
Home Alone and Sick
Hypoglycemic Unawareness
Impaired Glucose Tolerance
Immunization & Diabetes
Incretins-a Hormone Treatment
Injecting Insulin
Insulin Discovery-The Story
Insulin
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Insulin - the Key to Energy Management
Insulin Pumps
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Insulin Pump Infusion Sets
Insulin Pump Therapy
Immunization and Diabetes
Internet Health Sites
Islet Cell Transplantation
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Ketones
Kidney Disease - Reducing the Risk
Living with Diagnosis of Diabetes
Living Powerfully with Diabetes
Low Blood Glucose
Managing Diabetes
Managing Blood Glucose
Metformin
Nutrition Food Labels
Meal Planning
Your Medication Expert
Medication Research Studies
Metabolic Syndrome
Microalbuminuria
New Diabetes Technologies
Natural Medicines and Diabetes
No Need for Insulin?
Not Snoozing
Over-the-Counter Medications
Oral Health and Diabetes
Osteoporosis and Diabetes
Diabetes and OTC Medications
Pedicure Precautions
Peripheral Arterial Disease
Pet Diabetes
Planning for Pregnancy
Prebiotics and Probiotics
Preparing for Activity
Putting off Insulin
Reducing Stress of Surgery
Safe and Successful Travel
Schizophrenia and Diabetes
Sensible Snacking
Setting Health Goals
Setting Goals for Physical Activity
Sharps Disposal
Shorter Insulin Needles
Sleep - a Missing Link
Smart Snacking
Smart Summer Nutrition
Snack Bars
Snacking with Diabetes
Sodium
Social Media & Diabetes
Solving the Insurance Puzzle
Stress and Diabetes
Success in School
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Supporting Spouse with Diabetes
Sweeteners
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Think Positive with Diabetes
Tiny Bites Equal Big Calories
Travelling with Diabetes
Tips for a Better You
Tobacco Use and Diabetes
Top 10 Reasons to Exercise
Treating Low Blood Glucose
Treating Hypoglycemia - Role of Glucagon
Tune up Your Diet
Type 1.5 Diabetes
Type 2 Diabetes
Understanding Diabetes
Understanding Diabetes Medications
Understanding Ketones
Used Sharps
Urinary Incontinence
Vacationing with Diabetes
Vegetarian Eating for Diabetes
Vitamin D
Walking
Wise Choices About Natural Medicines
Wonderful Water
Natural Medicines & Diabetes
World Diabetes Day
Your Medicine Cupboard
Zimbabwe Hand Jive
Family Medicine
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ADHD in Children
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Antibiotic Use
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Aspirin Every Day?
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Back Pain Myths
Back Pain - Lower
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Doctor Visit
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5 Ways to Stay Healthy
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Canada's New Blood System
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Soy
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5 Tips to Manage Weight
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Breakfast is Important
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Diet Reality Check
Drink Up!
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Energy Drinks
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Healthy Diet, Healthy Smile
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Healthy Eating on Business Travel
Healthy Ethnic Meals
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Feeding Your Kids
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Food Chemistry 101
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Healthy Eating for Teens
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New Ingredients for Your Shopping Cart
Iron
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Essential Omega-3
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Power of Fruits & Veggies
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After a Heart Attack
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Changing Role of the Pharmacist
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15 Great Reasons to Breastfeed
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Breast Cancer Screening Guidelines Changes
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xx
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Family Health Online / Pharmacy at Safeway
Family Health Magazine - WOMEN'S HEALTH

Screening for Breast Cancer
How to do a breast self-examination

Many women worry about breast cancer, both as a concern for themselves and for the increased occurrence among women in general. Fortunately there are things individual women can do to increase the chance of early detection and cure.

Although the number of women getting breast cancer each year is rising worldwide, the number of women in Canada who die from the disease has been declining since 1990. Once the most common fatal cancer in women, it has fallen to being the second most common. One reason for this change is widespread screening programs that help to pick up breast cancer early, increasing the chances of cure. If the cancer is confined to the breast at the time it is discovered, the chance of cure is 70 to 90 per cent. Improved treatments are also playing an important role in reducing deaths from breast cancer.

Who is at risk of breast cancer?

The two biggest risk factors that predict breast cancer are being female and getting older. In women younger than 30, the risk is low at 0.3 per cent (3 in 1,000). Over the age of 50 the risk increases to 2 per cent (1 in 50). By the time women are over the age of 85 the risk has risen to 10 per cent (1 in 10). The likelihood also rises when a close female relative (mother, sister or daughter) has had breast cancer or when there is a history of exposure to a high dose of radiation before the age of 30. Other conditions that increase risk slightly include a history of benign breast disease, high alcohol intake, women who have had no children or had their first pregnancy after 30, women whose first menstrual period was at a young age or whose menopause is late in life. Although hormone replacement therapy after menopause may increase the risk slightly, birth control pills have not been shown to increase the risk.

Despite all of these things that may predict a person getting breast cancer, no one is guaranteed free of risk. One in every nine Canadian women is affected over a lifetime and even men can be affected!

What about screening to detect breast cancer?

The goal of screening in healthy women is to detect cancer early to increase the chances of survival and cure.

Screening for breast cancer has three important parts: breast self examination (BSE), clinical breast examination(CBE) by your doctor and mammography (or special x-ray of the breast).

Breast self examination

What is it?

Breast self examination (BSE) is a way for you to examine your breasts routinely and methodically for changes. This is how most breast cancer was found before breast screening programs were started. In fact, 69 to 80 per cent of breast cancers are still found during self-examination.

Why do BSE?

With regular examination you will become familiar with your normal breast structure. This increases the probability of detecting a new lump when it is still small and has not spread outside the breast. If a lump is cancerous and is confined to the breast, it is much easier to treat than if it has spread to nearby lymph nodes (particularly under the armpit) or other body organs.

Scientific study has shown BSE can save lives when done properly. The value of BSE is greatly increased by proper. The three elements of successful BSE are:

  1. Use the middle three fingers.
  2. Use the pads of the fingers, not the tips. Examine with fingers straight, don’t bend fingers.
  3. Visual inspection - look carefully at the breast. Who should do BSE and how often should it be done?
    All women over the age of 20 should do monthly self-examinations. If you are still having menstrual periods it is best to perform the examination at the time in the cycle when the breasts are least swollen, which is 10 to 14 days after the first day of a period. This way a lump may stand out more readily if it is there.

Regular, monthly BSEs can be done any day of the month if you are no longer menstruating. Some women choose to do BSE the same day each month (such as the first or last day of the month).

Many women are anxious about doing BSEs as they are unsure what “normal” breast tissue feels like. They fear they might not recognize a significant breast lump (especially women with naturally lumpy breasts). Normal breast tissue can feel soft, firm, smooth or lumpy. Because of the differences in the feel of breast tissue, it is important for you to become aware of what your breasts normally feel like. Regular self-examinations over the years will help you to be confident that you can find a worrisome change in your breast.

What if you find a lump in your breast?

If you find a lump or tender area, it should be checked by your doctor. About 85 per cent of lumps detected are benign (not cancer). They are most often fluid-filled cysts or solid lumps called fibroadenomas. They are often found on BSE and may cause pain.

Careful examination by your doctor can often given an indication of the seriousness of a lump in your breast. Sometimes further testing such as ultrasound, mammography, withdrawing fluid from the lump or a tissue sample is needed to help make a diagnosis.

Clinical Breast Examination (CBE)

Clinical breast examination follows the techniques of BSE but is done by a doctor at regular examinations or at times of concern. If you do BSE, examination by a doctor is also a “second opinion” of your own impression of your breast tissue. In either case, CBE is also an opportunity to review proper breast self examination. Regular clinical examination by your doctor is an important part of your breast cancer screening program.

Mammography

Mammography is a low dose x-ray exam of the breast. Like regular BSE and CBE, mammography is used in hopes of detecting breast cancer early.

Who should have a mammogram?

There are two types of mammograms:

  1. a screening type
  2. a diagnostic type

The difference between these two tests relates to their purpose. A screening mammogram is done at a particular time in a woman’s life when no abnormality is suspected. A diagnostic mammogram is ordered when a problem is suspected and it often requires a more detailed examination.

It is currently recommended that all women between the ages of 50 and 69 have screening mammograms every two years (along with annual CBE and monthly BSE).

There remains much controversy about doing screening mammograms in women from 40 to 49 years old. At the moment, however, it is not recommended in Canada.

For women under the age of 50, there may be some benefit to screening mammograms if certain risk factors are present. If there is a strong family history of breast cancer, for instance, screening mammograms should start five to 10 years earlier than the age at which the youngest family member was diagnosed. Again, it is important that this screening be done in collaboration with regular BSE and CBE. If you are in this risk group, a personalized breast care schedule should be discussed with your family doctor. Women who decide to screen before age 50 are usually advised by their doctor to have a yearly mammogram.

A diagnostic mammogram may be necessary when a lump is detected, by whatever method, or if there are symptoms such as breast pain, nipple discharge or skin abnormality.

Mammography does help to detect cancers early but it is not a perfect test. Sometimes it suggests cancer when it is not there and sometimes it does not pick up cancer in the breast of those who have the disease. These are important reasons to limit screening of women at higher risk and the age groups of women for whom routine mammography has been proven to be beneficial. This approach helps to minimize misdiagnosis and anxiety related to the test.

What is involved when someone goes for a mammogram?

The screening mammogram takes about 10 minutes and is done by a trained technologist. The breasts are x-rayed one at a time. After proper positioning of the breast, it is compressed to spread out the breast tissue. In this way, small lumps can be detected more easily. The compression only lasts a few seconds, but it may cause some discomfort.

Once the films are taken, a radiologist (an x-ray specialist) reviews the films and compares to previous mammograms, if they are available. Further x-rays may be suggested if an area of concern needs to be examined more closely.

What about radiation from the x-rays?

Given that radiation exposure is a risk factor for developing cancer, many patients worry about radiation received during a mammogram (a woman may have several screening mammograms in her lifetime). In women over 40 years there appears to be no increased risk and it is very small for women in their 20s and 30s. Its use in young women and children is reserved but it is considered a safe test in women over 40.

Other methods of detection

Genetic testing is being studied and may be able to identify women at risk for certain types of breast cancer. This research is ongoing and this type of testing is not yet generally available.

Research continues in the area of breast cancer screening and treatment. This research provides women with information and tools to deal with the many areas of breast disease. A good relationship with a family doctor, regular visits and patient education are important steps in the prevention of breast cancer and for the best chances of survival if it is found.

Key Points

1. Visual Check

2. Hand Check

Standing

Use the opposite hand for each breast.

3. Hand Check -Lying Down

What are you checking for? If you feel anything that is a different texture or movement than what you have felt before, consult your doctor. Remember that it may be normal for your breasts to be lumpy - you’re checking for something that wasn’t there last month.

FAMILY HEALTH is written with the assistance of
College of Family Physicans of Canada
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2015, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6    [WH_FHb91]
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