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Breast Checks and Self-Examinations

How often should I do a breast check? Does this pertain to a specific age bracket?

A clinical breast exam by a healthcare provider should occur at least once a year. While you do not need to perform examinations on yourself, it is important to know what is normal for you, and let your healthcare provider know if there are any changes from this baseline. As far as imaging goes, we advise starting screening mammograms at age 40 and continuing them once a year. If there is a family history [of breast cancer] or other risk factors, we may need to start earlier, and we may want to use additional tools like ultrasound or MRI to get the most thorough evaluation. All women should check in at age 30 to see if their doctor thinks they should start imaging earlier than 40.

What's considered normal when it comes to breast structure? What are some indications that something is wrong?

Each person has their own “normal.” Some women have firmer, denser breast tissue; others may have nipple inversion that has been there for years. If your mammogram is clear, it’s fair to consider this “your normal,” but we want to know if any changes occur from this baseline.
Some changes to look out for are:

• • Swelling, warmth, redness, or darkening of the breast
• • Change in the size or shape of the breast
• • Dimpling or puckering of the skin
• • Itchy, scaly sore, or rash on the nipple
• • Nipple discharge
• • Pain

Should I be concerned about changes I find while pregnant or nursing?

Many changes can occur to the breast during both pregnancy and lactation due to hormonal changes. If any localized findings are noted like a spot of redness, a lump, or significant one-sided findings, they should be brought to your doctor’s attention. The latest recommendations by the ACR advise to continue screening mammograms if they are due even while pregnant because the radiation exposure is so minimal that it will not harm the baby, but the testing will benefit the patient. Not all changes in the breast are cancerous. Sometimes, there are benign growths that are stimulated by hormones, or clogged ducts that can turn into a breast infection.

Is having pain or no pain an indication of anything specific?

While breast cancer doesn’t typically cause pain, if the pain is new for you, get it checked out. Pain can sometimes indicate the presence of an infection that would need antibiotics. There are also natural ways to fight infection, like Vitamin E or evening primrose oil, or eliminating dietary irritants like caffeine.

Does finding a lump or something unusual mean I probably have breast cancer?

No, don't panic! 80-85% of lumps turn out to be benign or non-cancerous when they are imaged. A few possible explanations for lumps are cysts or fibroadenomas, which are not risky. Now, this only refers to lumps that are felt. It’s better to just stay on track with screening imaging to prevent a lump from developing. If someone is called back for additional imaging after a screening, it’s important to remember the risk of the lump being a cancer is very low. Getting a mammogram callback can trigger anxiety in just about any woman. But out of all women called back after an inconclusive mammogram, less than 0.5% will have cancer.
About 4 out of every 100 women screened are recalled. Out of four people recalled, three will not have breast cancer. They might just be experiencing a normal breast change or a benign condition. Also, there's a slightly higher change of being recalled after your first mammogram than subsequent screenings.

How long after finding something I'm concerned about can I wait to see my doctor? Is finding a lump considered an emergency?

See your doctor and get a scan within a week. You need to get seen even sooner if there is redness, fever, pain, and concern for infection. If your doctor’s office is closed, you might need to go to the ER because treating breast infections early with antibiotics helps prevent it from turning into an abscess.

Mammography and Scanning

At what age can I rely on breast self-exams alone to be sure I am cancer free?

Never! While self-exams are important for overall breast health, they can never replace screening mammography. Screening mammography aims to detect breast cancer as early as possible — before you feel it during self-examination.

If I had a mammogram done this year, how often should I do a self-check?

While noticing changes in your breast is important, self-exams have not been shown to decrease mortality from breast cancer. It’s important that you notify your healthcare provider if you notice changes in the breast, including lumps, skin/nipple changes, or nipple discharge.

How often should I be getting a mammogram?

For average-risk women, you should have a mammogram done once a year starting at age 40. For women at increased risk of breast cancer, screening should begin earlier. We recommend all women undergo risk assessment by age 30 to know whether they will benefit from screening before age 40.

What's the difference between doing a mammogram, an ultrasound, and an MRI?

A mammogram is an x-ray of the breasts. Screening mammography is recommended for all women, once a year. Ultrasound is a different way to view the breasts, and some women with dense breast tissue may benefit from adding ultrasound to their screening mammogram. MRI is the most sensitive screening exam and is recommended for women at increased risk of developing cancer (lifetime risk greater than 20%).

What is dense breast tissue?

When viewed on a mammogram, breasts are composed of fibroglandular tissue and fat. As the ratio of fibroglandular tissue increases relative to fat, the “density” of the breast tissue increases. All breasts are scored on a scale of 1-4, with 4 being the most dense. Dense breast tissue can hide breast cancer on a mammogram. This is the reason we recommend ultrasound for certain women. A breast ultrasound may find additional cancers in women with dense breast tissue.