Breast Self Exam

With modern technology, breast cancer can often be detected at a very early stage of development when the chance for cure is highest. The key to cure is early detection and prompt treatment. Physical examination, mammography, and breast self-examination comprise an early detection approach.

Women over age 20 should practice the breast self-examination (BSE) monthly. BSE is best done one week after menstruation starts, or on the same day each month for the post-menopausal woman.

	Step 1. -- Bath or Shower Examine your breasts as you bathe or shower. Your hands will glide easily over wet skin.
	Step 2. -- Circular Motion Place one hand behind your head. With your other hand, press flat fingers gently in small circular motions. Begin with your index finger next to your collarbone. Move your hand in a circular fashion, clockwise around the breast. You will feel a ridge of tissue in the lower curve of your breast. When you reach the top of your breast, move in three fingers and continue circling and sliding around your breast. Continue until you reach the nipple. Repeat this step with your other breast.
	Step 3. -- Squeeze Nipple Squeeze the nipple gently between thumb and index finger. Any discharge, whether clear or bloody, should be reported to your physician.
	Step 4. -- Mirror After your shower, stand before a mirror and examine your breasts visually. Look for anything unusual, such as puckering skin, dimpling, scaling, or color changes.
	Step 5. -- Hands Behind Head Watching closely in the mirror, clasp hands behind your head and press elbows forward. You should be able to feel your chest muscles tighten. Notice the contour of your breasts.
	Step 6. -- Hands on Hip Press hands firmly on hips and bow slightly toward the mirror as you pull your shoulders and elbows forward. When you are aware of your breasts' natural contours, any future change will become apparent.
	Step 7. -- Lie Down Lie flat on your back with your left arm over your head and a pillow or folded towel under your left shoulder. This position flattens the breast and makes the exam easier. With your right hand, press flat fingers gently in small circular motions. Begin with your index finger next to your collarbone. Move your hand in a circular fashion, clockwise around the breast. You will feel a ridge of tissue in the lower curve of your breast. When you reach the top of your breast, move in three fingers and continue circling and sliding around your breast. Continue until you reach the nipple. Repeat this step with your right breast. Hand lotion will allow your hands to slide smoothly.

DIAGNOSIS

The diagnosis of breast cancer can only be made by pathological examination of breast tissue. A lump in the breast usually warrants biopsy even when the mammogram is described as being normal. Breast tissue may be obtained by needle aspiration biopsy or surgical biopsy.

Needle aspiration is used by some physicians to help differentiate between cysts and solid tumors. Cysts frequently disappear after aspiration and the removal of fluid. Cytological or pathological examinations of material removed in the aspiration can be used to identify the cancer. Ultrasound may help determine whether the lump is solid or cystic.

Surgical biopsy is generally performed under general or local anesthesia in an ambulatory surgical center. Excisional biopsy , the most commonly performed procedure, is used when lumps are small. In these cases, the entire tumor and a margin of normal tissue is excised. If the tumor is large, incisional biopsy may be done to remove a small amount of tissue for pathological examination. Tissue obtained from surgical biopsy can be evaluated by frozen section, which permits a diagnosis within 30 minutes and may be followed by definitive surgery; but most surgeons wait for a permanent section, which take about 24-48 hours. The latter approach is allows the patient time to discuss treatment options with the physician and is the more common approach today.

Breast cancer tissue should also be assayed for estrogen and progesterone receptors. These hormone receptor assays aid in predicting whether certain hormones influence the growth of the cancer. Women with positive hormone receptor assays are more like to respond to hormone therapy and also have a better overall prognosis.

Breast Cancer Prevention

Breast Cancer Treatments

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