Types of Breast Exams

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A week after my recent mammogram I received a letter from my doctor telling me that she had scheduled me for a breast ultrasound. Apparently I have some kind of abnormality that she doesn’t think is cancerous but needs to be looked at more closely. I had a breast cancer “scare” about fifteen years ago which turned out to be nothing, so I’m not particularly worried. But I did think that this might be a good time to brush up on breast disease and abnormalities, diagnostic tests and treatment.

I decided to start with types of breast exams, since this is the first line of defense in detecting and treating breast cancer:

BREAST SELF EXAMINATION (BSE)

One way to find breast cancer in its earliest stage is to complete monthly self-breast exams. Because breast tissue changes at different times of the month, these exams should be done at the same time of the month if you are still having periods. The Susan G. Komen Breast Cancer Foundation recommends that every woman over the age of 20 check for any change in the normal look or feel of her breasts. You should look and feel for a lump, hard knot, skin thickening, or dimples. Any changes should be reported to your doctor or nurse. Ask your doctor for information on completing your routine breast self-exams. You may also contact the Susan G. Komen Breast Cancer Foundation at 1-800-462-9273 for a card to hang in your shower to help you complete your monthly exams.

CLINICAL BREAST EXAMINATION

Every woman should have her breasts examined by a healthcare professional at least every 3 years, starting at the age of 20, and yearly after age 40. A physician can tell a lot about a lump simply by feeling it and the tissue around it. Non-cancerous lumps often may not feel the same as cancerous lumps. They can be harder and may be stuck to surrounding tissues rather than freely movable. Additional tests may be prescribed, including mammography, digital mammography, ultrasonography, or MRI.

If a lump feels like it is a cyst filled with liquid, the doctor may try to remove some fluid with a small needle. This is called aspiration. Based on these exams, the doctor may decide that no further tests are needed and no treatment is necessary. In such cases, the doctor may check you regularly to watch for any change.

MAMMOGRAM

The most common procedure used to diagnose breast cancer is the mammogram, an x-ray of the breast that uses a very low dose of radiation. It can look at the tissues within the breast. A special machine holds the breasts in place with pressure (compression). This simple procedure can reveal cancerous growths that are too small to feel. Although it may feel a bit uncomfortable, it takes only a few minutes to complete. Good compression of the breast is important because it reduces radiation exposure and gives the doctor a better view of abnormalities, which might be hidden behind normal breast tissue. Compression does not harm the breast tissue. If you have breast implants, a special mammography technique pushes back the implant to look at the breast tissue more completely.

The Susan G. Komen Breast Cancer Foundation and the American Cancer Society recommend annual screening mammography for women, starting at age 40, and a baseline exam between 35 and 40.

Special recommendations are made for women who have a strong family history of breast cancer or have been diagnosed with cancer at an age younger than 40. Women with a family history of breast cancer or who have personal concerns about their risk should talk with their doctor about when they should begin having mammography.

Annual screening mammograms in women age 40-49 have been shown to lower a woman’s chance of dying from breast cancer by 17%. For women between the ages of 50-70, a 33-60% reduction in mortality has been reported.

Mammograms are able to find lumps at a smaller size than we are able to feel.

The smallest tumor a mammogram can identify .2 inches to .4 inches
The average size lump found by yearly mammograms when the woman has had previous mammograms to compare the lump to .43 inches
The average lump found by first-time mammograms .59 inches, the size of a dime
The average size lump found by women through their monthly breast self-examination .81 inches (the size of a quarter)

The initial diagnosis of breast cancer may come from the breast self-examination, the physician’s clinical breast exam, or screening mammography. The gold standard continues to be the mammogram. Other tests that help in the diagnosis and staging of breast cancer are listed below.

ULTRASOUND

Ultrasound is also called sonography. This procedure uses sound waves far above the range of normal hearing to view images of the body. No radiation is used in this examination and there are no known health risks. If a suspicious area is identified by mammogram, an ultrasound is often used to explore that area more thoroughly. Ultrasonography can distinguish between a fluid filled cyst and a solid mass (which may or may not be cancer). The American College of Radiology (ACR) suggests that women with dense breasts may benefit from the use of ultrasound.

MAGNET RESONANCE IMAGING (MRI)

Magnet Resonance Imaging (MRI) is one of the most advanced diagnostic imaging tools available in medicine today. Using magnetic fields and radio frequency coils, remarkably detailed cross-sectional images of the body can help your physician diagnose your cancer. MRI does not use x-ray or radiation. Currently, an MRI is used to further assess a suspicious area; it is not used as a routine screening procedure.

The MRI may be more accurate than mammography in the early detection of malignant breast tumors in women with a hereditary risk of developing breast cancer. It might be the preferred test for younger women who have dense breast tissue. Physicians may also order an MRI for women who have a genetic linkage to breast cancer, as they are BRCA1 or BRCA2 positive. It is an appropriate test for women who have breast cancer and need further evaluation. It is also used for women who have implants that need to be checked for possible leakage.

An MRI is more than ten times as expensive as a mammogram. It also has a high false positive rate. This means that it may incorrectly identify breast lesions as being a cancer 20-50% of the time, when in fact the lesion is not cancerous. Thus, the MRI is not yet ready to be used as a screening test for most women.

COMPUTERIZED AXIAL TOMOGRAPHY (CAT SCAN)

The CAT scan uses x-rays and combines the use of a digital computer and a rotating device to make cross section photographic slices of organs and parts of the body. Not used as a screening tool, the CAT Scan is primarily used to evaluate deeper structures in the body for the presence or absence of metastatic disease, or spread of breast cancer to distant sites.

POSITRON EMISSION TOMOGRAPHY (PET SCAN)

This nuclear medicine technique can actually make an image of the internal organs based upon their metabolic activity. Radioisotopes (compounds containing radioactive forms of atoms) are introduced into the body to evaluate organ function or localize disease or tumors. The radioisotope is injected into a vein. In breast cancer, the PET scan is used for staging distant metastases, restaging patients with recurrence, and/or monitoring the response to treatment.

SCINTIMAMMOGRAPHY

Scintimammography is a nuclear medicine test. A small amount of radioactive tracer (dye) is given through the vein. The dye travels to the breast tissue. Scans are taken and the radiologist can differentiate between benign and malignant lesions. This procedure is used in addition to a mammogram and ultrasound. It can assist the surgeon with planning the biopsy.

SOURCE: Medtropolis.com’s Guide to Breast Cancer

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Ellen Keim

Ellen is a freelance writer, essayist and copy editor, living with three cats and a husband in Columbus, OH.

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