When To Start Breast Self
Health experts advise women to begin breast self-exams by the age of 20. Women should have a clinical breast exam by a physician every three years until the age of 40. After the age of 40, women should have a clinical breast exam and mammogram every year. It is recommended that women do a breast self-exam about a week after the first day of their period, when breasts are no longer swollen and tender due to hormonal fluctuations.
If The Cancer Comes Back
If cancer does return, your treatment options will depend on where it comes back, what treatments you’ve had before, and your current health and preferences. For more information on how recurrent cancer is treated, see Treatment of Recurrent Breast Cancer.
Its important to know that women who have had breast cancer can also still get other types of cancer. In fact, women who have had breast cancer are at higher risk for certain other cancers. Because of this, its important to follow the American Cancer Society guidelines for the early detection of cancer, such as those for colorectal cancer and cervical cancer. To learn more about the risks of second cancers and what you can do about them, see Second Cancers After Breast Cancer.
If You Have A Gene Mutation
If you have had tests that showed a change in a gene that increases the risk of breast cancer, the recommendations are slightly different.
UK guidelines recommend yearly MRI scans from:
- age 20 for women with a TP53 mutation
- age 30 for women with a BRCA1 or BRCA2 mutation
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If You Are Called Back
Around 4 out of 100 women are called back for more tests. If this happens, you might feel very worried. But many of these women wont have cancer.
If you are called back because your mammogram showed an abnormal area, you might have a magnified mammogram. This can show up particular areas of the breasts more clearly. These mammograms show the borders of any lump or thickened area. They can also show up areas of calcium .
You might also have an ultrasound scan of the breast or a test to take a sample of cells from the abnormal area
What Should You Look For
Its not just lumps that you should be checking for. There are several other indicators of breast cancer that you can look out for too. Get in touch with your doctor if you notice one or a combination of the following changes in your breast:
- Dimpling, puckering, or bulging of the skin
- Redness, soreness, rash, or swelling
- A nipple that has changed position
- An inverted nipple
- Clear or bloody fluid leaking from the nipple
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Clinical Considerations And Recommendations
How should individual breast cancer risk be assessed?
Health care providers periodically should assess breast cancer risk by reviewing the patients history. Breast cancer risk assessment is based on a combination of the various factors that can affect risk Box 1610111213. Initial assessment should elicit information about reproductive risk factors, results of prior biopsies, ionizing radiation exposure, and family history of cancer. Health care providers should identify cases of breast, ovarian, colon, prostate, pancreatic, and other types of germline mutation-associated cancer in first-degree, second-degree, and possibly third-degree relatives as well as the age of diagnosis. Women with a potentially increased risk of breast cancer based on initial history should have further risk assessment. Assessments can be conducted with one of the validated assessment tools available online, such as the Gail, BRCAPRO, Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm, International Breast Cancer Intervention Studies , or the Claus model 34.
Is screening breast self-examination recommended in women at average risk of breast cancer, and what should women do if they notice a change in one of their breasts?
Should practitioners perform routine screening clinical breast examinations in average-risk women?
When should screening mammography begin in average-risk women?
How frequently should screening mammography be performed in average-risk women?
How To Check For Breast Cancer
Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.
It’s important that every woman knows how to do a breast self-examination , as it can help in early detection of breast cancer, such as lumps, nipple changes, and more.
Being familiar with what is normal for you will make it easier to recognize any new developments. Furthermore, knowing what’s not normal for anyone can help prompt you to bring such issues to your doctor’s attention, should you notice them during your BSE.
This photo contains content that some people may find graphic or disturbing.
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Why Cant I Have Screening Mammograms
A mammogram is not recommended as a regular screening tool for women under 40 .
This is because:
- Breast tissue in this age group is naturally denser than in older women, meaning there is a greater concentration of glandular tissue versus fatty tissue in the breasts.
- Glandular breast tissue appears white on a mammogram, as do cancers, so it can be difficult in this age group to detect small tumours.
- This means young women might be subjected to unnecessary biopsies or cancers may be missed .
Ask Your Doctor For A Survivorship Care Plan
Talk with your doctor about developing a survivorship care plan for you. This plan might include:
- A suggested schedule for follow-up exams and tests
- A schedule for other tests you might need in the future, such as early detection tests for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
- A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
- Diet, physical activity, and other lifestyle modification suggestions
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Who Is At Higher Risk
One study from 2011 examined mammography for women at different ages and with different risk factors. The studys authors concluded that each womans decision about mammography screening should be based on the following risk factors: age, breast density, history of breast biopsy, family history of breast cancer, and personal beliefs about the benefits and harms of screening. This study supports the USPSTF guidelines that women at an average risk of breast cancer can start screening once every two years at age 50, and that women at a higher breast cancer risk should consider screening before age 50.
Women who are carriers of the BRCA genetic mutation were previously recommended to begin yearly mammograms between ages 25-30, since this mutation puts them at much higher risk of getting breast cancer. Newer studies have found that starting yearly mammograms before age 35 has no benefit and may instead be harmful. Women end up with higher exposure to radiation from mammograms over their lifetime, which increases their chance of getting radiation-induced breast cancer that they may not have gotten otherwise.
Guidelines For Genetic Testing For Breast Cancer
About 10% of breast cancers are related to inheritance of damaged genes. BRCA1 and BRCA2 are the genes most frequently implicated, but there are many other genes, such as PALB2, ATM, and CHEK2, that need to be considered as well. Genetic testing usually starts with a family member who has already developed a breast or ovarian cancer. If this individual is positive for a mutation then all of the other family members can be tested for the same mutation to determine who is high risk and who is not. If no one in the family is known to carry a mutation then the test is considered non-informative. That means the test was unable to tell us which relatives in the family are high risk. People who have inherited a damaged gene are at increased risk for breast and other cancers. The risk may be as high as 80% depending on the specific gene and family history. Guidelines for determining whether an individual should get genetic testing or not are constantly evolving. General criteria include:
- Someone in your family is known to carry a mutated gene
- Ashkenazi Jewish ancestry
- You were diagnosed with breast cancer before age 50
- A man in your family has been diagnosed with breast cancer
- You were diagnosed with ovarian cancer
- There are multiple breast cancers on one side of your family
- Cancer was diagnosed in both breasts
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Detecting Breast Cancer In Younger Women
While theres no way to predict who will get breast cancer, some factors put women at higher risk at a younger age. Breast cancer risk is higher in women with a family history of breast or ovarian cancers at a young age or who have an Ashkenazi Jewish heritage. Having had radiation therapy in the chest is another important risk to know about.
There are some steps you can take, including discussing your family cancer history with your doctor and taking advantage of genetic testing for BRCA and other genetic mutations, if offered, based on your health and family history.
Through research, we are learning more about cancer, genetics, and risk factors, says Dr. Andrejeva-Wright. Young women should be aware of their family history and keep their doctors updated over time as it changes.
Also, while guidelines no longer call for monthly at-home breast exams, Dr. Andrejeva-Wright urges women of all ages to be breast aware. She advises women to do a breast self-exam at least quarterly and to learn all they can about their risk factors.
Breast awareness entails knowing your family history of breast and other cancers, says Dr. Andrejeva-Wright, It also means knowing any behavioral factors that may increase your risk of developing breast cancer, such as weight gain and alcohol consumption , and doing something about it.
Breast Changes To Look Out For
See a GP if you notice any of the following changes:
- a change in the size, outline or shape of your breast
- a change in the look or feel of the skin on your breast, such as puckering or dimpling, a rash or redness
- a new lump, swelling, thickening or bumpy area in one breast or armpit that was not there before
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For Women With A Family History Of Breast Cancer:
- a clinical breast exam every six months starting no later than ten years before the age of the earliest diagnosis in the family
- an annual mammogram starting no later than ten years before the age of the earliest diagnosis in the family
- possible supplemental imaging for women with dense breast tissue
- possibly alternating between a breast MRI and a mammogram every six months, as determined by your physician
Breast Lumps In Teenagers
It can be normal to feel lumps when your breasts are developing and these often disappear on their own.
If a lump causes you any discomfort, appears to get bigger or youre worried about it, talk to someone such as your GP. You may also want to talk to someone in your family or a school nurse.
Although its very unlikely that theres anything wrong, a doctor can check it out and should put your mind at rest. You can ask to see a female doctor or the practice nurse if this will make you feel more comfortable.
Very occasionally lumps are a sign of a benign breast condition. Benign means harmless, and a benign condition will not become a breast cancer. The most common benign lump as the breasts are developing is known as a fibroadenoma.
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Should I Go For Breast Screening
Its important that you have access to enough information about the benefits and harms of breast screening to make the decision.
You can talk to your own doctor or nurse. Or you can contact the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday.
Screening Letters Sent To The Public
Cancer Care Ontario sends letters to women turning 50 inviting them to get screened for breast cancer through the Ontario Breast Screening Program. Women ages 51 to 73 who have not been screened in at least 3 years also receive a letter inviting them to get screened.
We also send letters to women ages 50 to 74 reminding them when it is time to return for screening and informing them of their results, if they are normal.
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Who Should Have A Regular Screening Mammogram
The biggest risk factors for developing breast cancer are being a woman and getting older. BreastScreen Australia targets women aged 50 to 74, as 75% of all breast cancers occur in women over the age of 50.
- Screening mammograms are often less reliable for women under 40 years of age. The density of breast tissue in younger women often makes it difficult to detect cancers on mammograms.
- All women aged 40 to 49 years who have no breast symptoms also have free access to the BreastScreen Australia program should they choose to a have a screening mammogram.
- All women aged 50 to 74 years are encouraged to have a free mammogram every two years through BreastScreen Australia.
- Women aged 75 and over who have no breast symptoms also have free access to the BreastScreen Australia program. They should discuss whether to have a mammogram with their doctor.
What Happens If My Mammogram Is Abnormal
An abnormal mammogram does not always mean that there is cancer. But you will need to have additional mammograms, tests, or exams before the doctor can tell for sure. You may also be referred to a breast specialist or a surgeon. It does not necessarily mean you have cancer or need surgery. These doctors are experts in diagnosing breast problems. Doctors will do follow-up tests to diagnose breast cancer or to find that there is no cancer.
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When To Start Screening
We recommend mammogram screening to start no earlier than age 40 and no later than age 50 for women of average risk for breast cancer, and continue through to at least age 74, says Dr. Andrejeva-Wright. Screening mammography should occur at least once every two years. For women whose screening mammograms show they have dense breasts, an extra testa breast ultrasoundis recommended.
Dr. Andrejeva-Wright says it is important to talk with a health care provider about when you should start getting mammograms, based on your unique health profile, and to make an appointment to see your doctor if you notice any unusual breast changes.
Any time a woman feels a breast mass, which does not go away, while doing a breast self-exam at any age, she should get it checked out, says Dr. Silber.
More than half of the time, women detect breast cancers themselves when they notice an unusual breast change. Whenever there is a new mass or lump, tell your doctorit should be evaluated by a clinical physical examination followed by breast imaging, says Dr. Andrejeva-Wright. Other signs to be aware of include asymmetry of the breasts and nipple changes such as discharge or peeling skin around the nipple.
Says Dr. Andrejeva-Wright, These symptoms dont mean you have breast cancer, but its a reason to seek an opinion from a medical provider.
How Do You Check Yourself For Breast Cancer How Do You Decrease Your Risk
Each year, more than 40,000 women die of breast cancer. You can check yourself for breast cancer with just your hands and the right technique. In fact, applying these selfed groomed skills can decrease your risk. Although there is no cure for this horrendous disease, modern medicine offers an abundance of treatment options that can be lifesaving. Of course, as with any cancer treatment, starting early is key.
Each year in October, we observe National Breast Cancer Awareness Month. With fall getting underway, now is a great time to review some tips on how to detect breast cancer early and keep you and your loved ones healthy.
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Body Image In Young Women After Breast Cancer
Another hurdle young women face is how breast cancer treatments and their side effects affect body image.
There are incredible demands placed on women in American society about their appearance, says Dr. Silber, and I would not be truthful if I didnt say that a lot of women really struggle not only with treatment but with the aftermath. Its hard because how someone looks can be a part of their self-worth. They may have lost their hair and gained some weight. Their breasts dont look the same. To act like thats not a thing is not fairof course, it matters.
Young women may be looking for a partner at a time when breast cancer treatment causes them to experience body changes that women generally dont encounter until theyre older and postmenopausal: hot flashes and/or weight gain in the abdomenthe meno-pot.
Its different when these changes happen at 20 and 30, says Dr. Silber, who explains that hormonal therapies are used for certain types of breast cancers to control tumor growth and discourage recurrence. But, this life-saving treatment, which a woman will need to keep taking as long as she lives, puts female breast cancer survivors into premature menopausemany years or even decades before their peers.