Detecting Breast Lumps

Breast cancer can be treated most effectively if it is detected early, before it has grown very large or spread to other sites. The main ways to detect breast cancer are:

• Mammography



• Breast examination by a doctor or nurse



• Breast self examination



• Ultrasound



• MRI

Mammograms

An x-ray of the breast known as a mammogram can detect some cancers that are too small to be felt. However, sometimes lumps that can be felt are not detected in a mammogram. Women of all ages should have their breasts examined every year by a physician or trained health professional.

Much controversy has taken place about when it is best for women to begin getting regular mammograms. Based on recent research data, the National Cancer Institute recommends that:

• All women in their 40s or older who are at average risk for breast cancer should have screening mammograms every one to two years. (The American Cancer Society suggests annual mammograms.)

• All women who are at higher risk for breast cancer should ask their doctors about when and how often to schedule screening mammograms.

There are two kinds of mammography:

• Screening - x-rays that are used to look for breast changes in women who have no signs of breast cancer.

• Diagnostic - prescribed for women who have unusual breast changes, such as a lump, pain, nipple thickening or discharge, changes in breast size or shape, or who have had a suspicious screening mammogram.

Don't simply assume that a mammogram is normal if your doctor doesn't contact you with results. Call and ask.

Clinical Breast Exam

Because some cancers cannot be detected in mammograms, women also should have periodic breast exams by a doctor or nurse. The provider will examine your breasts while you are sitting and while you are lying down.

The provider looks for:

• Changes in the skin, such as dimpling, scaling or puckering.



• Nipple discharge or nipple inversion.



• Difference in size or shape between the two breasts.

Breast Self Examination (BSE)

Women should begin examining their breasts each month beginning around age 20. Doctors are urged to talk with their patients about the limitations of BSE. Research has shown BSE plays a small role in detecting breast cancer compared with mammograms, clinical exams and self-awareness. (Self-awareness is being familiar with how your healthy breasts feel and look like.)

The American Cancer Society (ACS) says evidence does not show monthly BSE has any advantage over annual mammograms and exams by your doctor. The ACS urges you not to substitute BSE for regular mammograms and a doctor's exam. However, the ACS still says BSE is one way for women to know how their breasts normally feel and to notice any changes. Mammograms continue to be the gold standard in breast cancer detection and can pick up tumors several years before a lump can be felt.

The best time to do BSE is two to three days after completion of the menstrual period. Although the following information provides general guidelines, it's best to ask your health care provider to show you how to perform BSE to be certain you are doing it correctly.

First, look in the mirror and see if you detect any lumps or thickness, swelling, puckering, dimpling, redness or soreness of the skin, as well as changes in nipple size or shape. Also squeeze the nipple to see if there is any discharge.

Standing upright with one hand behind the head, use the flats of your fingertips to gently feel the breast, making small circles around the nipple, then make larger and larger circles as you work your way around the entire breast. Change and repeat the process on the other breast. Complete the same process while lying down. Also feel the collarbone area and the armpit on each side.

Ultrasound

Ultrasound sends high-frequency sound waves into the breast, creating patterns of echoes that are converted into an image of the breast's interior (a sonogram). Ultrasound is used to help radiologists evaluate some lumps that can be felt but are hard to see on a mammogram. It distinguishes cysts (fluid filled lesions) from solid masses in the breast. However, unlike mammography, ultrasound cannot detect small tumors. It can help with deciding the extent of breast abnormalities, especially for surgical resection.

Magnetic Resonance Imaging (MRI)

The use of MRI for detecting breast cancer is coming out of the research stage and into clinical practice and is available in selected centers. MRI uses radiowaves and magnets, a special breast coil and a computer to scan the patient to produce its images. Its usefulness in identifying tissues that are abnormally active is being studied. MRI can be helpful in deciding the extent of breast abnormalities, especially for surgical resection. It is also used along with mammography for women with dense breasts and those who are at high risk. It can help tell between a benign and cancerous lump.

Related Articles Is That Lump Breast Cancer? What to Do When the Diagnosis Is Cancer Treatment Options The Road to Wholeness If You're Concerned About Breast Cancer What Every Woman Needs to Know Who Gets Breast Cancer?

External Sources Understanding Breast Cancer Treatment: A Guide for Patients, National Institutes of Health, National Cancer Institute. Understanding Breast Changes, National Institutes of Health, National Cancer Institute.

This article was reviewed and updated June 2007.

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