Breast Cancer and Screening

A woman's breasts are always changing. Changes occur during the menstrual cycle, pregnancy, breastfeeding, and menopause (when menstrual periods end). You may also notice changes in your breasts if you use hormonal contraception such as birth control pills, if you use hormone therapy (HT), or if you have breast implants.
Along with these normal changes, problems may occur. While most of these are minor, a few can be serious. One major problem, breast cancer, is the second leading cause of cancer deaths among women.  If, however, it is found and treated early, most women can be cured. This is why routine breast self-exams, mammography, and checkups by your doctor are important.
Screening tests are used to find a health problem early. If they are done routinely, they may detect an abnormality before symptoms are felt. Three of the common tests for breast problems include the following:

1. Mammography
2. Doctor's exam of the breasts
3. Breast self-exam

For the best results, all three tests should be done. If any one of these tests shows a problem, it should be further investigated.

Mammography is used to examine the breast tissue by X-ray. This test can find tiny lumps before they can be felt. The results of your first exam are compared with later ones to detect changes. The size of your breasts or the use of breast implants does not change the need for the test.  Mammograms are more useful in women aged 40 years and older because older women's breasts are less dense making it is easier to detect lumps.

Breast cancer is more common in older women. Thus, women aged 40–49 years should have mammography done every 1–2 years, and women aged 50 years and older should have it done yearly.  If you have an increased risk of breast cancer, your doctor may suggest that you have this test done more often or before age 40 years.
A breast exam by a doctor takes only a short time. The breasts are first examined for any changes in size or shape. The doctor also looks for puckers, dimples, or redness of the skin. You should tell your doctor if you have seen any discharge from your nipples or any other changes. He or she will then check each breast for signs of a problem.
Because all women are at risk for breast cancer, you should be aware of how your breasts feel. Therefore, regular breast self-exams can help. If you see a change in your breasts at any time, you should have your doctor examine them. He or she will review when you first had symptoms and how long they have lasted. Your doctor will also ask questions about your medical history to check for other factors that could point to an increased risk of breast cancer.

Some women worry about a link between breast cancer and the hormones that are used in oral contraceptives (birth control pills) and HT. It does not appear that oral contraceptives increase the risk of breast cancer. Women who take combined HT (estrogen and progestin) may have an increased risk. The risk appears to be small, but increases throughout the time that HT is taken. If you choose to take HT, take the smallest possible dose for the shortest amount of time that works for you.

Most breast conditions are benign; however, breast cancer can occur. Most importantly, breast problems can be treated with success if they are found early. To help detect abnormal breast conditions early, check your breasts every month, visit your doctor promptly at the first sign of any problem, and follow your doctor's advice about routine mammography.