• a swelling of part of the breast
• skin irritation or dimpling
• nipple pain or the nipple turning inward
• redness or scaliness of the nipple or breast skin
• a discharge other than breast milk

Breast Self Exam (BSE)

The best time to do BSE is about a week after your period ends, when your breasts are not swollen or tender. If you are not having regular periods, do BSE on the same day every month.

Breast Self Exam
Lie down with a pillow under your right shoulder and place your right arm behind your head.

Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast.

Press firmly enough to know how your breast feels. A firm ridge in the lower curve of each breast is normal. If you're not sure how hard to press, talk to your doctor or nurse.

Move around the breast in a circular, up and down line, or wedge pattern. Be sure to do it the same way every time, check the entire breast area, and remember how your breast feels from month to month.

Repeat the exam on your left breast, using the finger pads of the right hand. (Move the pillow to under your left shoulder.)

If you find any changes, see your doctor right away.

Repeat the examination of both breasts while standing, with your one arm behind your head. The upright position makes it easier to check the upper and outer part of the breasts (toward your armpit). This is where about half of breast cancers are found. You may want to do the standing part of the BSE while you are in the shower. Some breast changes can be felt more easily when your skin is wet and soapy.

For added safety, you can check your breasts for any dimpling of the skin, changes in the nipple, redness, or swelling while standing in front of a mirror right after your BSE each month.

Clinical Exams

You should have a breast exam by a doctor, nurse, or other health professional every year if you are 40 or over. If you are between 20 and 39, you should have this exam every three years. The doctor will first examine the breasts for any changes in shape or size and then gently feel the breasts, and also examine the area under both arms.

Mammography
A mammogram is an x-ray picture of the breast. It can find breast cancer that is too small for you or your doctor or nurse to feel. Studies show that if you are in your forties or older, having a mammogram every 1 to 2 years could save your life.

As you get older, your chances of getting breast cancer get higher. Cancer can show up at any time--so one mammogram is not enough. Decide on a plan with your doctor and follow it for the rest of your life.

Mammograms are quick and easy. You simply stand in from of an x-ray machine. The person who takes the x-rays places your breast between two plastic plates. The plates press your breast and make it flat. This may be uncomfortable for a few seconds, but it helps get a clear picture. You will have x-rays taken of each breast. A mammogram takes only a few seconds.

Very low levels of radiation are used. While many people are worried about exposure to x-rays, the low level of radiation used for mammograms does not greatly increase the risk of breast cancer. For example, a woman who has radiation as treatment for breast cancer will receive several thousands rads, the unit that measures radiation. If a woman has yearly mammograms beginning at age 40 and continuing until she is 90, she will have received only 10 rads.

A mammogram alone cannot prove that an area of concern is breast cancer. To confirm whether cancer is present, a small amount of tissue must be removed and examined under a microscope. This procedure is called a biopsy.

Biopsy 
The only way to know for sure if you have breast cancer is to do a biopsy. Cells from your breast are removed so they can be studied in the lab. There are several kinds of biopsies. In some, a very thin needle is used to draw fluid and cells from the lump. Other methods use a larger needle or surgery to remove more tissue.

If cancer is found, a 2-step approach is almost always used. A biopsy is done first, followed by a decision concerning treatment. The biopsy can be done in the doctor's office or on an outpatient basis in the hospital. You will then have time to talk to your doctor and your family before deciding on a course of treatment.

The tissue removed during the biopsy is examined in the lab to see whether the cancer is invasive or not. The biopsy is also used to decide the type of cancer present.

The biopsy sample is also given a grade. The grade helps predict the outcome (prognosis) for the patient because cancers that closely resemble normal breast tissue tend to grow and spread more slowly. In general, a lower grade number means a slower-growing cancer, while a higher number means a faster-growing cancer.

Finally, the biopsy sample can also be tested to see whether it has receptors for certain hormones such as estrogen and progesterone. If it does, it is often referred to as ER-positive or PR-positive. Such cancers tend to have a better outlook than cancers without these receptors and are much more likely to respond to hormonal therapy.

Ductogram
A ductogram is a test that is sometimes helpful in finding the cause of a nipple discharge. If there is a discharge, some of the fluid may be collected and examined under a microscope to see if any cancer cells are present.

Diagnostic Mammogram
Diagnostic mammography is the next step if a mass or problem is found during mammography screening. Diagnostic mammography examines the breast using an x-ray, usually magnified, to evaluate the breast abnormality. This type of x-ray may show if the mass is benign (not cancer) or if a biopsy is needed for further investigation. Seventy percent of cases that undergo a biopsy are benign. Consult with your doctor if a biopsy is needed to determine the best procedure for you. Women should be rechecked in four to six months.

Breast Ultrasound
Breast ultrasound is used to view breast abnormalities by sending high frequency sound waves across the body section. The echoes from the sound waves bounce back, producing an outline, which is translated by a computer and displayed on the screen. While ultrasound is the only way to determine if a cyst is present without prodding the mass with a needle, it does not detect small calcium deposits, often the earliest stage of cancer. Therefore, mammography continues as a necessary screening process for women. An ultrasound my also help doctors guide the needle during a biopsy procedure.

Gene Testing
Medical researchers are now able to look within cells, and are making new discoveries that explain how genes are related to cancer and other diseases. They have identifies specific genes linked to breast cancer and other cancers that run in families. Tests are becoming available for women and family members who choose to find out if they have inherited the genetic changes that increase their risk for cancer.

Genetic testing can tell if a woman has these mutated genes, but it cannot predict whether a woman will get breast cancer. This is not a test for all women. Talk to your doctor if you have a history of breast cancer in your family. Genetic testing is expensive and is not covered by some health plans. People with positive results might not be able to get insurance, or coverage might only be available at a much higher cost.

It’s important to consider carefully the benefits, risks, limitations, and the far-reaching consequences of gene testing.

Results

After taking your medical history and doing a thorough physical exam, including a clinical breast exam, your doctor may suggest a diagnostic mammogram and/or breast ultrasound. These imaging tests can sometimes tell if a lump is benign.

Staging is the process of finding out how far the cancer has spread. This is very important because your treatment and the outlook for your recovery depend on the stage of your cancer. The staging system of the American Joint Committee on Cancer (AJCC), also known as the TNM system, is the one used most often for breast cancer.

TNM descriptions can be grouped together into a simpler set of stages, labeled stage 0 through stage IV (0-4).

In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious cancer.

After looking at your test results, the doctor will tell you the stage of your cancer. Be sure to ask your doctor to explain your stage in a way you understand. This will help you both decide on the best treatment for you.