Medical Breast Exams

Guidelines

Age 20 - 35
Breast self-exam once a month, one week after onset of menstruation
Physical Exam Yearly

Age 35 - 40
Breast self-exam once a month, one week after onset of menstruation
Baseline mammography
Physical exam yearly

Age 40 - 50
Breast self-exam once a month, one week after onset of menstruation
Mammography every one to two years
Physical exam yearly

Age 50 + Breast self-exam once a month, one week after onset of menstruation; post-menopausal women - the same day each month
Mammography yearly
Physical exam yearly

Standard Procedures

Aspiration: Fine needle aspiration of the breast is a simple, inexpensive diagnostic procedure which is reported to be highly accurate. Breast aspiration may be performed in the doctor’s office in a matter of minutes, with a minimal amount of discomfort to the patient. The procedure is performed using a very fine needle – one much smaller than that used to draw blood from a vein. The skin when the needle is introduced may or may not be anesthetized (frozen) with a local injection. Because the results of the aspiration are available within a short period of time, it spares the patient unnecessary anxiety. Since it is a simple office procedure which leaves no scar, it is psychologically more acceptable to women than an open biopsy. If the fine needle aspiration shows no cancer cells, but your doctor notes any suspicious or worrisome mass, further tests are indicated.

Core needle biopsy: A core needle biopsy is a diagnostic procedure reported to be highly accurate in identifying the presence of a malignant tumor. The larger size needle used in this procedure is able to obtain tissue samples from areas where calcifications are seen on mammography. The core needle is usually guided into position with the use of ultrasound then multiple tissue samples are removed.

Needle localization: Sometimes very small lumps which cannot be felt but do show up on a mammogram can be very hard to locate and biopsy. In order to locate the exact site of such a small lump, a special type of needle, with a fine hookwire inside it, is guided into the lump during mammography. When the needle reaches the exact site of the lump the small hooked wire is then extended past the needle into the lump. It is left in the lump until the patient is brought into surgery for the surgical removal of the lump. By localizing the lesion, the physician is able to remove the lump without removing a large amount of normal tissue.

Mammography: This is a two-level X-ray of the breasts. Although not foolproof, to date this is considered the best method to detect lesions (abnormal growths). It can detect lesions in breast tissue which might otherwise go unnoticed because they are very small or deeply buried and cannot yet be felt during palpation. This makes mammography particularly valuable as a screening tool in detecting early breast cancer. If you are symptom-free, it is recommended that you have a ‘baseline’ mammogram sometime by age 40 to establish what is normal in your breasts. The American Cancer Society's booklet, Cancer: Facts and Figures 1996, still recommends women ages 40-49 have screening mammography every 1 to 2 years even if they are asymptomatic. If a suspicious lump is found, even if it is not seen on a mammography, it should be biopsied. Whatever your age your doctor may recommend a mammography more frequently if your medical history indicated that you are at high risk for breast cancer.

Approximately half of the women who have a mammogram complain of discomfort. This discomfort is due to the breast compression, which is necessary in order to obtain a clear picture of the breasts, with the lowest amount of radiation.

Do not be alarmed if, after your mammogram, you notice some temporary discoloration of the skin of one or both breasts. This is the result of the breast compression. Remember, though this may be uncomfortable, it is absolutely necessary because it (1) improves the accuracy of the test and (2) reduces the amount of radiation needed to get a clear picture.

If discomfort continues, it will be relieved by buffered aspirin or Tylenol which you can take if you are not allergic to either of these medications.

Be aware that: (1) Breast compression is not dangerous and does no damage to the breast tissue; and (2) the discomfort is only temporary.

The mammogram is the most accurate method, to date, of detecting breast cancer, but it does not pick up everything. It is therefore very important that you do your monthly breast self-examination and see your doctor whenever he/she recommends.

NOTE:
Do NOT use deodorant or talc dusting powder under your arms before having a mammogram.

Because breast cancer, when detected early, can usually be cured, these additional examinations may be life-saving.

Although mammography is generally assumed to be less accurate in pre-menopausal women because of their greater breast density, most of the small, minimal, and easily curable cancers would have been missed in the Breast Cancer Detection Demonstration Project study if mammography had not been done.

Monthly breast self-examinations and mammography (as recommended by your physician or the American Cancer Society) are both essential.

All suspicious lumps should be biopsied for a definite diagnosis, even when the mammography findings are described as normal. Many mammographers request a woman notify the person taking the mammogram if she is on hormones.

The National Cancer Institute recently dropped its recommendation that women under the age of 50 have regular mammograms. The National Cancer Advisory Board, the American Cancer Society and the American College of Radiology however would not go along with the Institute’s change in policy and continue to firmly recommend that women in their 40’s have mammograms every one to two years.

Microcalcification: A common sign of breast disease found by mammography is microcalcification -- very small deposits of calcium, deposited in breast tissue. Thew calcifications are usually of varying shapes frequently occur in tight groups, and are found in benign (NOT CANCEROUS) and malignant CANCEROUS) conditions. Sometimes these calcifications, seen on mammogram, occur without an associated mass.

Clusters of microcalcifications are routinely biopsied. However, when the cytology (cell examination) is benign but the type of calcification is still of concern, it may still be necessary to surgically remove or excise the calcification for tissue or histologic examination.

Mammography, whether done by X-ray film or the Xerox technique (an X-ray that produces a blue image on paper), is considered the "gold standard" for detection of early breast cancer. Follow-up with mammography of those patients with microcalcifications is very important. The finding of a change in the pattern, or a few new calcifications, may allow early detection of a small or "minimal" cancer. This why it is necessary to have more frequent mammography when recommended by your doctor.

Ultrasound: Breast ultrasound is a procedure used to further evaluate a breast abnormality or lump seen on mammography. It is an imaging technique , which uses high frequency sound waves to scan the breast to locate and measure abnormal changes or lesions in the breast. Ultrasound can determine if a breast lump is solid (tumor) or filled with fluid (cyst).

Breast ultrasound is not meant to replace the mammogram. Unlike mammography, ultrasound is not able to detect small calcification.

Open Biopsy combines surgical removal with microscopic examination of the suspicious tissue. No matter how sensitive a doctor’s fingers, he/she cannot feel the difference between cancerous and non-cancerous cells; that difference appears only under a microscope. Biopsy is the most accurate method of diagnosing the nature of a breast lump, and your doctor will recommend it if he or she cannot otherwise be absolutely certain that a lump or other breast symptom (nipple discharge, dimpling, or discoloration of the skin, etc.) is harmless. It is important to remember that 80 percent of all breast biopsies do prove that the growth in question is benign.

Since most malignant lumps occur in the upper outer quadrant of the breast, this is a common site for biopsy incision. Another such site is the edge of the areola surrounding the nipple. Depending on the size of the lump, part or all of it will be removed for evaluation.