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Introduction: We Know What You’re Going Through
Mary's doctor calls to give her the results of her mammogram. The doctor
says, "It is not normal, and I think we need to biopsy the area in question."
Mary's first thought is, "Could this be breast cancer?"
Another woman, Peg, just found a lump in her breast, She notes that the lump
wasn't there last month. Her first thought: "I'm sure it isn't breast cancer."
Women react differently to being told that something may be wrong with their
breasts. Whatever their feelings and thoughts, at some point these women will
want information about their situation.
This booklet is provided by the American Cancer Society. Women who have had
breast lumps, suspicious mammograms, and breast biopsies helped write it. They
have gone through something similar to what you may be going through now.
This booklet offers the basics of benign breast conditions, diagnostic tests
such as different types of biopsies, and breast cancer. It also gives general
information on coping with your concerns and fears, and guidance on where to
find emotional support. There are many details that we cannot cover in one
booklet. So, in each section, we've added a list of questions that you might
take up with your doctor and nurse. We've also left space for you to write your
own questions.
This booklet is not meant to answer all your questions. It should not take
the place of talking with a doctor or nurse.
We explain many medical terms that you will hear during breast evaluation and
diagnosis. As you learn these terms, you will understand better what is being
said to you. Knowing these terms will also help you communicate clearly with
your health care team. The American Cancer Society has a free Breast Cancer
Dictionary that many women, and their doctors, find very helpful. To request it,
call us at 1-800-ACS-2345.
Remember: Just because your doctor wants you to have a biopsy does not mean
you have breast cancer. Most breast lumps are not cancer. However, having a
biopsy (removal and testing of a suspicious area of the breast) is the only way
to know for sure. See a doctor about any changes in your breasts. Even if you
need a biopsy, 4 out of every 5 results are not cancer.
Benign Breast Conditions: Not All Lumps Are Cancer
If you find changes or something unusual in one of your breasts, it is
important to see a doctor or nurse as soon as possible. However, please remember
that most breast changes are not cancer.
Benign (non-cancerous) breast conditions are very common, and they are never
life-threatening. The 2 main types are fibrocystic changes and benign breast
tumors.
Fibrocystic Changes
Fibrocystic changes are benign changes in the breast tissue that occur in
about half of all women at some point in their lives. Although this used to be
called "fibrocystic disease," this is not a disease at all. These changes can
cause cysts (fluid-filled areas) and areas of lumpiness, thickening, tenderness,
or pain in the breast. If they are painful, cysts can be treated by aspirating
(draining) the fluid using a needle. Lumps and areas of thickening caused by
fibrocystic changes are almost always harmless.
Doctors cannot tell from a physical exam alone if a lump or thickening is
caused by fibrocystic changes. In these cases, doctors will want to do further
testing (mammogram or biopsy) to ensure that the suspicious area does not have
any cancer.
If fibrocystic changes are uncomfortable or painful, doctors may suggest that
you avoid caffeine or reduce your salt intake. In severe cases, doctors can
prescribe medications that may help reduce or relieve the symptoms.
Benign Breast Tumors
Benign breast tumors are non-cancerous areas where breast cells have grown
abnormally and rapidly, usually forming a lump. Benign breast tumors are
sometimes uncomfortable but they are not life-threatening.
A biopsy (removal and examination of some of the suspicious breast tissue) is
required to determine if the tumor is benign or cancerous.
If the benign tumor is large, it may change the breast's size and shape.
Depending on the size and number of benign tumors, doctors may or may not
recommend excision (removal) by surgery.
If the benign tumor involves the tissue of the milk ducts, it may cause
abnormal discharge from the nipple. In some cases, this can be treated by
surgery to remove the tumor.
Other Benign Breast Conditions
Mastitis is a breast infection that most often affects women who
are breast-feeding. The breast may become red, warm, or painful. Mastitis
is treated with antibiotics.
Fat necrosis sometimes results when an injury to the breast heals,
leaving scar tissue that can feel like a lump. A biopsy can tell if it is
cancer or not. Sometimes when the breast is injured, an oil cyst
(fluid-filled area) forms instead of scar tissue during healing. Oil cysts
can be diagnosed and treated by aspirating (draining) the fluid inside.
Duct ectasia involves an abnormal milk duct. It is common and most
often affects women in their 40s and 50s. The symptoms are usually a
green, black, thick, or sticky discharge from the nipple, and tenderness
or redness of the nipple and area around the nipple. Duct ectasia can also
cause a hard lump, which a biopsy can distinguish from cancer.
Diagnostic Tests for Breast Conditions
Two main tests to diagnose breast conditions are mammograms and ultrasound.
Diagnostic Mammogram: If a woman has noticed breast changes or symptoms,
or if a screening mammogram has detected a suspicious-looking area, her doctor
may arrange for her to get a diagnostic mammogram. During diagnostic mammograms,
more x-ray views (pictures) are taken of the breast and of the suspicious area
in particular. (See Appendix A for more information.)
Breast Ultrasound: Breast ultrasound uses sound waves to create a
computer image of the inside of the breast. This test is sometimes used to
evaluate breast abnormalities that are found during mammography or physical
exam. Ultrasound is useful for identifying some breast changes, such as those
that can be felt but not seen on a mammogram. It is the easiest way to tell if a
cyst is present without placing a needle into it to draw out fluid.
Ductogram: Ductograms are sometimes used to determine the cause of nipple
discharge. A ductogram, also called a galactogram, involves placing a small
amount of fluid into the nipple through a tiny plastic tube. The fluid can be
seen on an x-ray, which can then show if there is a mass inside the duct.
Biopsy: While imaging tests like the mammogram and breast ultrasound can
locate a suspicious area, they cannot tell whether or not the area is cancerous.
A biopsy is the only way to tell for sure if a benign breast condition or cancer
is really present.
Taking a biopsy involves removing some cells from the suspicious area to look
at under a microscope. A biopsy can be done using either a needle or surgery to
remove part or all of the tumor. The type of biopsy to use depends on the size
and location of the lump or abnormality.
If your doctor thinks you don't need a biopsy, but you feel there's something
wrong with your breasts, follow your instincts. Don't be afraid to discuss this
with your doctor or go to another doctor for a second opinion.
Second Opinions
Before you have a biopsy, you may want to get a second opinion. This way, an
additional expert from a hospital or mammography facility will read your
mammogram. You can ask your doctor to arrange this for you, or you can have the
films sent to the expert you have selected.
If you are not being seen at a large cancer center, you can ask your hospital
or clinic to help. The facility should send any previous mammograms and your
most recent mammogram to a center that specializes in mammography and diagnosis
of breast cancer. Or, if the facility will make copies, you can take them
yourself for a second opinion. Be sure to find out ahead of time if the second
facility or doctor will accept copies; some facilities will read only original
x-rays.
It takes great skill and experience to accurately read a mammogram. You want
to be sure that your x-ray is being read by an expert.
Types of Biopsy Procedures
Each type of biopsy has advantages and disadvantages.
Fine needle aspiration biopsy (FNAB) involves drawing out a few cells
and/or fluid from a lump through a thin needle (smaller than those used for
blood tests). FNAB is the least invasive type of biopsy. However, in some cases,
FNAB cannot give an answer as to whether or not the tissue is cancerous. In
these cases, another type of biopsy is needed.
If you are still having menstrual periods (that is, if you are
pre-menopausal), you probably know that "lumpiness" can come and go each month
with your menstrual cycle. However, if you have a troublesome lump, the doctor
may want to do a FNAB to see if it is a cyst (a liquid-filled sac) or a solid
growth (tumor). If an aspiration is performed and the lump goes away after it is
drained, it usually means it was a cyst, not cancer. Again, most breast lumps
are not cancer.
Core needle biopsy (CNB) is similar to FNAB. A slightly larger needle is
used to withdraw small cylinders (or "cores") of tissue from an abnormal area of
the breast. The procedure is usually done with local anesthesia (the woman is
awake during the procedure but the breast is numb) in the doctor's office. The
needle is inserted 3-5 times to get the samples, or "cores." This is more
invasive and takes longer than an FNAB, but it is more likely to give you a
definite result.
The doctor performing the FNAB or CNB usually guides the needle into the
abnormal area while palpating (feeling) the lump. If the abnormal area is too
small to be felt, a radiologist or other doctor may use needle placement, a
stereotactic instrument, or ultrasound to guide the needle to its target.
The stereotactic needle biopsy procedure uses a computer to analyze
information from mammograms. The computer then determines exactly where in the
abnormal area to place the needle tip. This procedure is often used to biopsy
microcalcifications (calcium deposits).
Ultrasound-guided biopsy uses an instrument that emits sound waves and a
computer to generate images of the breast abnormality. A doctor can use this
test to guide a needle into very small tumors or cysts.
Surgical biopsy involves removing part or all of the abnormal tissue for
examination. The surgery may be done in the doctor's office or in an outpatient
clinic under local anesthesia and, usually, medicine to make you drowsy. There
are 2 kinds of surgical biopsies:
- an incisional biopsy, which removes part of the lump
- an excisional biopsy, which removes the whole lump
Incisional biopsies are not often used for a breast cancer diagnosis.
If the lump or suspicious area is too small to be felt, the radiologist may
use wire localization during the operation to help the surgeon find it.
Local anesthesia, like a dentist injects to work on your teeth, is given to numb
the breast. Using x-ray images as a guide, the radiologist inserts a wire into
the breast, through a needle, until the tip of the wire touches the suspicious
area.
The wire has a tiny hook on the end. This hook holds the wire in place while
the patient is taken to the operating room. The surgeon can then use the wire as
a guide to the area to be biopsied. The wire along with the breast tissue and
fluid are removed, and the tissue and fluid are examined by the pathologist (a
doctor who specializes in interpreting lab test results). In either type of
biopsy, if cancer is found, you will need to have further treatment such as
surgery, chemotherapy, hormone therapy, or radiation.
Surgery and Biopsy: Two-Step or One-Step?
In breast cancer care today, if you need to have more surgery after a biopsy
has shown breast cancer, it is almost always done at a separate time from the
biopsy. This is called a two-step procedure. Sometimes, however, it is possible
to have a one-step procedure, in which the biopsy and surgery are done at the
same time. If you have a one-step procedure, you should know all of your
treatment options beforehand, because you must make important choices before the
one-step procedure begins.
The Two-Step Procedure
Just a couple of decades ago, a one-step procedure was the only choice.
Today, most women and their health care team prefer to schedule further surgery,
if needed, at a different time from the biopsy. Many studies have shown that the
emotional burden of breast cancer is easier to bear if biopsy and treatment are
done at separate times.
In the two-step approach, the biopsy is usually done on an outpatient basis.
Local anesthesia is used, so you stay awake. Many women choose local anesthesia
plus a sedative through a vein (intravenous, or IV). The sedative soothes any
nervous or anxious feelings you may have during the procedure. The biopsy can
take about an hour. You can go home an hour or two later, when the sedative
wears off.
With the two-step procedure, if the diagnosis is breast cancer, you usually
don't have to decide on treatment immediately. With most breast cancers, there
is no harm to your health in waiting a few weeks. This gives you time to talk
about your treatment options with your doctors, family, and friends, and then
decide what's best for you. (More information on treatment options is available
by calling the American Cancer Society at 1-800-ACS-2345 or visiting our Web
site at www.cancer.org.)
Questions to Ask Before a Biopsy
- What type of biopsy do you recommend? Why?
- How does the size of my breast affect the procedure?
- Where will you do the biopsy?
- What exactly will you do?
- How long will the biopsy take?
- Will I be awake or asleep during the biopsy?
- Can I drive home afterward or will I need someone to drive me?
- If you are using a wire to localize, will you need to check its placement
by ultrasound or with a mammogram?
- Can you draw me a picture showing the size of the incision and the size
of the tissue you will remove?
- Will there be a hole there? Will it show afterward?
- Where will the scar be? What will it look like?
- How soon will I know the results?
- Should I call you or will you call me with the results?
- Will you or someone else explain the biopsy results to me?
- When can I take off the bandage?
- When can I take a shower?
- Will the stitches dissolve or do I need to come back to the office and
have them removed?
- Will there be bruising or changes in color of the skin?
- When can I go back to work? Will I be tired?
- Will my activities be limited? Can I lift things? Care for my children?
Your Breast Biopsy Results
After the tissue sample is removed, the specimen is sent immediately to the
laboratory, where it is looked at by a pathologist. If your biopsy report comes
back negative (or benign), this means that no cancer was found. If there is any
question about the results of the biopsy or if for any reason you feel
uncomfortable about the results, you may wish to seek a second opinion. Once you
feel comfortable that you do not have cancer, be sure to:
- have regular mammograms
- continue seeing your health care professional for routine breast exams
- be aware of any changes in your breasts, and report changes to your
doctor right away
A mammogram may show a lump or other change that can't be felt by a physical
exam. Physical exams may find a lump a mammogram can't see. If you should ever
notice a change in your breasts yourself, let your doctor know right away.
Breast changes do not always mean that breast cancer is present. (See Appendix B
for more information on finding cancer early.)
If the biopsy indicates that the lump is cancerous, the results will show
several important things about the cancer:
Is It In Situ or Invasive?
The biopsy report may say that the cancer is in situ. This means
that the cancer arose in a milk gland (lobule) or duct (tube that carries milk
from the lobule to the nipple) but has not spread to the surrounding fatty
breast tissue.
Invasive cancer means that the tumor arose in a lobule or a duct and has
spread into nearby breast tissue. This type may spread to the lymph nodes or
to other parts of the body.
How Fast Is It Likely to Grow and Spread?
Pathologists (doctors who specialize in interpreting laboratory test
results) look at the appearance and arrangement of the cells to determine the
cancer's grade. The grade assigned to the cancer indicates how slowly
or quickly the cancer is likely to grow and spread.
Pathologists also use measures called ploidy, cell proliferation rate,
Ki-67 tests, and HER2/neu tests to give the medical team a better idea of how
quickly or slowly the cancer is likely to grow and spread.
Will It Respond to Hormone Therapy?
Estrogen and progesterone receptors are molecules that recognize and
respond to the presence of the female hormones estrogen and progesterone. Some
breast cancers have these receptors, and others do not. Finding out if a
cancer has these receptors will help determine how likely it is to respond to
hormonal therapy.
Questions to Ask about Your Biopsy Results
Are these results definitive, or is another biopsy procedure needed?
If it is not cancer...
- Is any follow-up needed?
- When should I get my next screening mammogram?
If it is cancer...
- Is the cancer in situ or invasive?
- If the cancer is in situ, is it a type of cancer that can become
invasive?
- Does the cancer appear to be growing and/or spreading slowly or
quickly?
- Is the cancer likely to respond to hormonal therapy?
- What types of tests will you recommend to determine the stage of the
cancer?
- Where can I get more information about breast cancer and treatment?
Coping: Waiting for the Results
Learning that you might have breast cancer can be a very difficult event. If
you have a biopsy and have to wait for the results, the waiting can be a
frightening time, during which many women experience a variety of strong
emotions, including disbelief, anxiety, fear, anger, and sadness. It is
important to recognize that these feelings are normal. Any coping strategy
should help you find productive ways to deal with the physical and emotional
challenges you are facing.
Remember, too, that what works for you may be different from what works for
others. Some women find comfort in talking with many people about their breast
condition, while others may wish to keep it very private. While some women wish
to be heavily involved in their testing decisions, others may wish to place
their trust almost entirely in their health care team. The ways in which this
event will affect your lifestyle and your body are unique, and your coping
strategy will also be unique.
Getting Emotional Support: You Are Not Alone
You will find resources and support--including your own inner strengths--that
you did not know existed.
If you are married or in a committed relationship, what you are going through
will have an impact on that relationship. Waiting for your biopsy test results
is a family challenge, as well as a personal one.
Other women who have been through difficulties similar to what you're going
through now can be your strongest allies. Talking with them can be very helpful
and reassuring. You can reach out--or simply listen--to others who understand
your feelings and concerns.
If you learn that your diagnosis is breast cancer, you may find it very
helpful to talk with someone who has already been through the breast cancer
experience. The American Cancer Society's Reach to Recovery Program, which is
available in most communities, is one of several programs that may help. Reach
to Recovery can put you in touch with a woman who has been diagnosed and treated
for breast cancer.
To talk with or receive a visit from a Reach to Recovery volunteer, call your
local American Cancer Society office or 1-800-ACS-2345. Also, the Resources
section at the back of this booklet has more information on Reach to Recovery
and other resources for you and your family.
Other Coping Strategies
Here are some other coping strategies you may want to try:
Increase your knowledge. Some women find that learning as much as they
can about breast health gives them a sense of control over what happens. If
you are interested in additional information about breast health or breast
cancer, please contact your American Cancer Society. (See the Resources
section below.)
Express your feelings. Most women find that giving some kind of
expression to their feelings can help them maintain a positive attitude. You
might choose to talk with trusted friends or relatives, keep a private
journal, or even dance, sing, paint, or draw to express yourself.
Take care of yourself. Take time to do something you enjoy every day.
Prepare your favorite meal, take a bubble bath, go for a walk, meditate,
listen to your favorite music, read a good book, or watch a funny movie.
Exercise. If you feel up to it and your doctor agrees that you're
ready, start a mild exercise program, perhaps one involving walking, yoga,
swimming, or stretching. Exercise can help you feel more in control of your
body.
Reach out to others. Widening your circle of friends, whether on your
own or through support organizations, can help you remember that you're not
alone. It also gives you more people with whom to share your fears, hopes, and
personal accomplishments. It makes the waiting not so lonely. Talk to a Reach
to Recovery volunteer. Interact with one or more support groups in your
community.
Additional Resources
National Organizations
American Cancer Society
For cancer-related information, Reach to Recovery, and other services for
people with cancer and their families.
1-800-ACS-2345 (1-800-227-2345)
www.cancer.org
American College of Radiology
A professional society that focuses on the practice of radiology, safety, and
quality standards.
1-800-227-5463
www.acr.org
National Breast Cancer Coalition
An organization that advocates for public policy related to breast cancer
issues.
1-800-622-2838
www.natlbcc.org
National Cancer Institute
Toll-free information line for questions about cancer.
1-800-4-CANCER (1-800-422-6237)
www.cancer.gov
The Susan G. Komen Breast Cancer Foundation
An international not-for-profit organization dedicated to eradicating breast
cancer as a life-threatening disease by advancing research, education,
screening, and treatment.
1-800-462-9273
www.komen.com
Y-ME National Organization for Breast Cancer Information and Support, Inc.
Support and counseling for women with breast cancer (24-hour hotline).
1-800-221-2141
www.Y-ME.org
American Cancer Society Publications
To receive the following publications, call 1-800-ACS-2345 or the local
American Cancer Society office listed in your telephone book. In addition, ask
about other materials that might be helpful.
After Diagnosis: A Guide for Patients and Families (Booklet Code #9440)
Breast Cancer Questions and Answers (Booklet Code #5009.03)
Breast Reconstruction after Mastectomy (Booklet Code #4630)
Sexuality and Cancer: For the Woman Who Has Cancer and Her Partner (Booklet
Code #4657)
Talking with Your Doctor (Booklet Code #4638)
Understanding Chemotherapy (Booklet Code #9458)
Understanding Radiation Therapy (Booklet Code #9459)
NCCN/ACS Breast Cancer Treatment Guidelines for Patients (Booklet Code #9405)
A Breast Cancer Journey (Book Code #9414)
American Cancer Society Patient Programs
The following programs are provided free of charge by the American Cancer
Society. Please call the local Society office listed in your telephone book or
1-800-ACS-2345 for more information.
Reach to Recovery: Breast cancer survivors provide one-on-one support and
information to help individuals cope with breast cancer. Specially trained
survivors serve as volunteers, responding in person or by phone to the concerns
of people facing breast cancer diagnosis, treatment, recurrence, or recovery.
I Can Cope: Adult cancer patients and their loved ones learn about the
cancer experience while building their knowledge, coping skills, and positive
attitude. In this series of educational classes, health care professionals
provide information, encouragement, and practical tips in a supportive
environment.
Look Good...Feel Better: Through this free service, women in active
cancer treatment learn techniques to restore their self-image and cope with
appearance-related side effects. Certified beauty professionals provide tips on
makeup, skin cancer, nail care, and head coverings. This program is a
collaboration of the American Cancer Society with the Cosmetic, Toiletry, and
Fragrance Association Foundation and the National Cosmetology Association.
"tlc": A magazine and catalogue in one, "tlc" supports women dealing with
hair loss and other physical effects of treatment. The magalog offers a wide
variety of affordable products, such as wigs, hats and prostheses, through the
privacy and convenience of mail order.
Group support programs: Group support programs for cancer patients and/or
their families may be available in your community. These may include groups
specifically related to breast cancer. Groups meet on a regular basis and
provide an opportunity to share experiences, concerns, and coping strategies
with other people in similar situations. Your local American Cancer Society can
tell you what group support programs are available in your area.
Cancer Survivors Network (CSN): Created by and for cancer patients and/or
their families, this "virtual" community offers convenient accessibility to
survivors, caregivers, and all those touched by cancer. It is a welcoming, safe
place for people to find hope and inspiration from others who have "been there."
Services include radio talk show conversations and interviews, individual
stories, personal Web pages, discussion forums, an Expression Gallery, and more
available online at www.cancer.org or by phone at 1-877-333-4673 (HOPE).
Appendix A: What Is Breast Cancer?
Breast cancer is the development of abnormal cells in the breast. These cells
are very different from normal, healthy cells. These cells begin to grow out of
control and produce more cells that grow into tumors, or growths and can spread
to other parts of the body.
Breast cancer develops over time, beginning with one tiny, abnormal cell.
Usually this takes a long time, but sometimes the type of cancer is very
aggressive and the tumor develops quickly.
Likelihood of Having Breast Cancer
Breast cancer is the most common cancer that women may have to face in their
lifetime (excluding skin cancer). It can occur at any age, but it is much more
likely to occur after age 40 and as women get older. Some women--because of
certain factors--may have a greater chance of having breast cancer than other
women.
These factors include:
- a personal history of breast cancer
- inherited changes (or mutations) in breast cancer-related genes (called
BRCA1 and BRCA2 genes)
- previous radiation treatments to the chest area
- two or more close relatives with breast or ovarian cancer
- a relative (mother, sister, grandmother, or aunt) on either side of the
family with breast cancer before age 50
- male relatives with breast cancer
Some factors may increase the chance of having breast cancer by only a small
amount, such as:
- beginning your menstrual periods at an early age (also called early
menarche)
- going through menopause at a late age
- having no children
- having your first pregnancy after age 30
- gaining weight as an adult
- excessive use of alcohol
Most breast cancers occur in women who have none of these risk factors, other
than getting older, so it's important that all women try to find these cancers
early through mammography, clinical breast examination, and being aware of any
breast changes.
Rumors About Breast Cancer Risk Factors
People with fears about breast cancer sometimes start unfounded rumors about
what causes breast cancer. These rumors can be hurtful and frightening to
others.
For example, some Internet rumors state that antiperspirants and underwire
bras can increase a woman's risk of developing breast cancer. There is no
experimental or clinical evidence to support either of these claims.
Furthermore, antiperspirants do not contain cancer-causing substances and do not
block such substances from getting out of the body. We know that injuries to the
breast do not cause cancer, and that breast cancer is not something a woman
"gets" or "catches," like a case of mumps.
If you hear claims about new causes of breast cancer, speak with your doctor
before changing your lifestyle or personal habits. The American Cancer Society
also has up-to-date information on cancer research and recent findings available
by calling 1-800-ACS-2345 or by visiting www.cancer.org.
Appendix B: Guidelines for Early Detection of Breast Cancer
Breast cancer is most treatable when it is found early. There is no reliable
way to predict who will develop breast cancer and who will not. For these
reasons, routine early detection tests (checking for breast cancer when there
are no symptoms present) are recommended. The following are the guidelines
published by the American Cancer Society to ensure early detection of breast
cancer:
- All women age 40 and older should have a mammogram every year for as long
as they are in good health.
- Women age 40 and older should have a clinical breast examination (breast
exam by a health professional) every year. This exam should be done close to
or preferably before the mammogram.
- Women ages 20 to 39 should have a clinical breast examination every 3
years.
- Women should report any breast changes to their health professional right
away. Breast self-examination (BSE) is an option for women starting in their
20s. Women should be told about the benefits and limitations of BSE.
- Women at increased risk (for example, family history, genetic tendency,
or past breast cancer) should talk to their doctors about the benefits and
limitations of starting mammograms when they are younger, having additional
tests (for example, ultrasound or MRI), or having more frequent exams.
Breast Changes
Early breast cancer is usually--but not always--painless. In its very
early stages, it is too small to find by palpating (touching) the breast. This
means that there may not be any symptoms present. At this stage of breast cancer
growth, the screening mammogram can detect the changes before symptoms appear.
As the tumor grows larger, it can feel like a lump or thickness.
Breast cancer is often found in the upper, outer portion of the breast, but
it can occur anywhere in the breast. Some signs to watch for are:
- a lump or thickening of tissue anywhere in the breast
- skin dimpling or puckering of the breast
- a nipple that is pushed in (inverted) and hasn't always been that way
- discharge from the nipples that comes out by itself and is not clear in
color, staining your clothing or sheets
- any change in the shape, texture (raised, thickened skin, for example),
or color of the skin
These are all changes that you may be able to see or feel yourself. Having
these changes, though, does not mean you have breast cancer. They can appear for
other reasons. Always tell your doctor or nurse right away about any changes you
find. If you are interested in examining your own breasts, ask your doctor or
nurse to show you how to do a breast self-examination.
Any suspicious changes in the breast tissue may also be visible or felt by a
health professional during a clinical breast examination. A clinical breast
examination is simply a checkup in which the doctor or nurse touches and gently
presses the breast tissue in a circular or vertical pattern, looking for lumps,
thickening, or other abnormalities. Some doctors may squeeze the nipples gently
to check for discharge.
While breast examinations are very important, breast tumors often develop
without any signs or symptoms. That's why mammograms are so important.
Appendix C: Mammograms: Finding Hidden Breast Cancer
One of the best ways a woman 40 or older can defend herself against breast
cancer is to have yearly mammograms.
What Is a Mammogram?
A mammogram is a special type of x-ray that shows an image of the inside of
the breast. Mammograms use radiation, but the amount is very low and is not
harmful.
Mammograms can be done in a radiology facility, a hospital or clinic, or a
doctor's office. There are 2 kinds of mammograms: screening mammograms and
diagnostic mammograms.
A screening mammogram is an x-ray of the breast of a woman who is
asymptomatic, or has no breast symptoms or problems. Women over 40 should get
yearly screening mammograms to see if there are changes they cannot yet detect
in their breast tissue. Because most breast cancers do not cause symptoms, a
screening mammogram is usually the only way to catch them in their early, most
treatable stage.
Mammograms are usually not very useful for women younger than 40. The reason
is that breast tissue in most younger women is too dense to give a satisfactory
x-ray image. Also, a young woman's breast tissue is more sensitive to radiation
-- even the low, safe dose that is used in today's mammograms. For women who
have family members that have had breast cancer and whose doctors recommend that
they start screening before they reach age 40, mammograms along with other
imaging tests that can be used.
Mammogram Results
When doctors look at the mammogram result, they compare the x-rays from
previous mammograms and look for differences between the breast images.
Sometimes the x-ray will show tiny pieces of calcium in the breast called
microcalcifications. Most microcalcifications are harmless, but in some cases,
they can be a sign that a cancer or a precancerous condition is present. The
doctor will look at the shape and arrangement of the microcalcifications to
determine if a biopsy is needed. Sometimes, the doctor may see an area of the
breast that looks a little different but not enough to report the mammogram as
not normal. In these situations, the doctor may ask that the mammogram be
repeated in about 6 months.
The mammogram may also detect the presence of a mass, or suspicious-looking
area of tissue. Masses are not necessarily a sure sign of cancer. The doctor
will evaluate the size, shape, and margins (edges) of the mass to determine the
likelihood of cancer. He or she may recommend further testing to determine
whether or not it is cancer.
While mammograms are the best way to detect cancer in its early stages, a
mammogram alone cannot prove that a suspicious area is cancer. If cancer is
suspected, further testing will be needed.
Remember:
- Only 2 to 4 mammograms out of every 1,000 lead to a diagnosis of cancer.
- Approximately 10% of women will need to have more mammograms after the
first one is taken. Don't be alarmed if this happens to you. Sometimes this
happens if there is a technical problem with the x-ray film, or if the film
was hard to read. Only 8%-10% of these women will need a biopsy, and 80% of
those biopsies will not be cancer.
- Breast cancer can be curable, especially if it's caught early enough.
Revised 4-04
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