Breast Cancer Screening

Screening is a systematic evaluation of a “normal” individual to see if there is any underlying disease. Screening for breast cancer implies that a person with no signs or symptoms or having a suspicious or doubtful symptom or who is ‘at risk’ for cancer is evaluated for cancer.

This is required for all women but more so for those at high risk, who need screening more often. By the time a breast lump can be felt, it would have reached a few centimeters and a minimum of stage 2 cancer or more. As the size of the tumor increases, the chance of it spreading increases and survival decreases.

There is no screening programme as such in place as per Indian medical council guidelines, in our country. We extrapolate information from trials in the West and apply them for our women. As per those trials, maximum benefit is gained by screening women in the age group of 50-70 years. The sensitivity of screening investigations is less in the age group of 40 – 50 years and may result in more unnecessary biopsies and procedures being done. None the less, since our average age of diagnosis is 47 years (as against 63 years in the West), it is usually recommended that women do screening after the age of 40 years. If an annual mammogram is not feasible, we encourage women to do a monthly breast self-examination at the least. Sizes of tumour detected –
Women undergoing annual / biannual mammogram screening – 0.5-1cm
In women who regularly do breast self-examination (once a month) – 1.5-2.0cm
In women who do irregular breast self-examination – 2.5cm
In women who do not do breast self-examination – 3.5cm
Thus, screening in some or other form, helps in early detection.

By screening, the aim is to detect the cancer even before it can be felt, so that the outcome is good.

The National Comprehensive Cancer Network (NCCN) recommends screening as follows:

  1. Women at normal risk, 20 to 40 years of age
    • Clinical breast examination: every 1 to 3 years.
    • Breast self-examination every month
  2. Women at normal risk, over 40 years of age
    • Annual clinical breast examination by a qualified and trained doctor
    • Annual mammography for those in the age group 40-50 years and every 2 years for those above 50 years
    • Breast self-examination every month
  3. Women with high risk of breast cancer
    • Annual clinical breast examination by a qualified and trained doctor
    • Breast self-examination every month
    • Annual mammography:
      • For women who have received radiation therapy to the chest, a mammogram should be done annually from the age of 25 years.
      • For women with a family history of breast or ovarian cancer, annual mammogram should start by 35 years of age or earlier depending on the age of the primary case.
      • For women with proven genetic susceptibility to breast or ovarian cancers or those with first or second degree relatives with breast or ovarian cancers, an annual mammogram should start around 25 years of age
  4. MRI of the breast: in the above high risk group , an annual MRI is also recommended as an adjunct to mammogram

 

What is clinical breast examination?

This is a visit to a breast clinic with a trained and qualified breast doctor, who will:

  • Evaluate the patient’s history for any evidence of breast cancer and also to categorize the risk of breast cancer
  • Performs a general check up
  • Performs a breast examination to detect any abnormality

The aim is to detect any cancer early or allay the fears of any cancer, clinically

What is breast self-examination?

Breast self-examination is a systematic examination of the breast, at regular intervals, aimed to familiarize a woman to her breasts and to be able to detect any irregularity or lump in the breast, nipple, skin or armpit A woman should learn the right technique of examining her own breasts to detect any lump (cancerous or not). It is best done every month just after a menstrual period, during bath.

When a breast self-examination is done, it aims to look for any abnormality in the breasts and not looking for cancers.

The procedure:

Your doctor will teach you how to do this.

Step 1: Look at your breasts while you stand in front of a mirror, with chest exposed, with arms by your side. Look for any irregularities, changes in size, shape, contour, dimpling, rash, redness, scaliness of the nipple or breast skin, retraction of nipples, discharge from nipples, change in size and shape from earlier appearance.

Then raise your arms over your head and examine as above.

Then press your hands on your waist, press inwards and tighten your chest muscles and examine as above. Turn from side to side and look for any changes. Place your hands on the waist and bend forward and look for any changes in breast shape.

With your arms by your side, check the armpit with the other hand, for any lumps or thickening.

Any changes, however minor should be reported to your doctor.

Step 2: Lie down and place a pillow under your right shoulder and right arm behind your head. Use the finger pads of the middle three fingers-not the tips- of the left hand to feel for lumps in the right breast. Use overlapping circular motions of the finger pads to feel every inch of the breast tissue.

Use light pressure to feel the tissue closest to the skin, medium pressure to feel a little deeper and firm pressure to feel the tissue closest to the ribs and chest.

Use an up and down pattern starting at your underarm and move slowly to the middle of the chest bone. Be sure to check the entire breast, going below your breast till you feel the ribs and up till you feel the collar bone. Repeat the examination on the left breast.

SEE YOUR DOCTOR IF YOU NOTICE ANY OF THE FOLLOWING:

  • Lump, hard knot, or thickening in the breast
  • Change in size or shape of the breast
  • Dimpling or puckering of the skin
  • Rash, redness, or scaliness of the nipple or breast skin
  • Blood-stained nipple discharge
  • New breast pain that does not go away t Recent retraction of the nipple
  • Hard knot in the underarm

 

© 2016 Columbia Asia

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