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.
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!
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 (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.
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:
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.
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 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 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.
There are two types of mammograms:
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.
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.
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.
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.
Use the opposite hand for each breast.
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.