Mammograms
A mammogram is an x-ray image of a breast produced by mammography. There are two types of mammograms:
- A screening mammogram. This is for women who have no problems with their breasts, and consists of two x-ray views of each breast
- A diagnostic mammogram. This is for evaluation of new abnormalities or for patients with a past abnormality requiring a follow-up. In this case multiple x-rays are taken, from different angles of certain areas of the breast(s).
Where are they offered?
Mammograms are offered in a variety of locations, such as hospitals, outpatient clinics, physician’s offices and mobile breast exam centers, just to name a few.
When should you get a breast exam?
It is important that doctors find breast cancer early, it is therefore recommended that:
- Women from the age of 20 should have a mammogram every three years
- Women older than 40 should have mammograms every 1 to 2 years
What is often recommended by physicians is that you perform a self breast exam at least once a month. This self breast exam (SBE), in combination with the regular mammogram is the best way of finding cancer at an early enough stage. You should keep in mind that mammograms can often show a breast lump before it can be felt, meaning that a self-breast exam is not a substitute for a mammogram.
Mammogram Results
If an abnormal area shows up on your mammogram, you may need to have more x-rays, the diagnostic mammograms. You may also need a biopsy. A biopsy is the only way to tell for sure if cancer is present. Mammograms are the best tool doctors have to find breast cancer early. However, mammograms are not perfect:
- A mammogram may miss some cancers. (The result is called a “false negative.”)
- A mammogram may show things that turn out not to be cancer. (The result is called a “false positive.”)
- Some fast-growing tumors may grow large or spread to other parts of the body before a mammogram detects them.
Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. The chance that the radiation doing any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each x-ray. You should also ask for shields to protect parts of your body that are not in the picture.
Clinical Breast Exam
- A breast examination by a health professional (such as your doctor, nurse, nurse practitioner) is an important part of routine physical checkups. As indicated in our section about mammograms, you should have a clinical exam at least every three years starting at age 20, and every year at age 40. A clinical breast exam may be recommended more frequently if you have a strong history of breast cancer.
- The best time to undergo a breast exam is soon after your menstrual period ends, because your breasts will not be as tender and swollen as during your period. This makes it easier to detect any unusual changes. If you have stopped menstruating, you should schedule the yearly exam on a day that’s easy to remember, such as a birth date.
- Your healthcare provider will ask you detailed questions about your health history, including your menstrual and pregnancy history. Questions might include what age you started menstruating, if you have children and how old you were when your first child was born.
- A thorough breast exam will be performed. For the exam, you undress from the waist up, and your healthcare provider will look at your breasts for changes in size or shape. Your provider may ask you to lift your arms over your head, put your hands on your hips or lean forward. He or she will examine your breasts for any skin changes including rashes, dimpling or redness. This is a good time to learn how to do a self- breast exam if you don’t already know how.
- As you lay on your back with your arms behind your head, your healthcare provider will examine your breasts with the pads of his/her fingers to detect lumps or other changes. The area under both arms will also be examined.
- Your healthcare provider will gently press around your nipple to check for any discharge. If there is discharge, a sample may be collected for examination under a microscope. A thorough clinical breast exam may take about 10 minutes.
Self Breast Exam
Examining your breasts is an important way to find breast cancer early. Not every cancer can be found this way, but it is a critical step you can and should take for yourself. No woman wants to do a breast self-exam (BSE), and for many it is a frustrating experience. However, the more you examine your breasts, the more you will learn about them and the easier it becomes for you to tell if something unusual has occurred. Making a habit of doing a monthly self breast exam will help you to familiarize yourself with how your breasts normally look and feel. The best time to do a SBE is several days after the end of your period, when your breasts are the least likely to be swollen. If you are no longer having periods, choose a day that’s easy to remember, such as a birthday.
It is important not to panic if you think you found something out of the ordinary. Most women have some lumps or lumpy areas in their breasts. Eight out of ten breast lumps that are removed are benign, non-cancerous. It is also important to keep in mind that changes can occur due to aging, your menstrual cycle, pregnancy, menopause, or birth control pills.
Breasts tend to have different “regions.” The upper, outer area – around your armpit – tends to have the most prominent lumps and bumps. The lower half of your breast can feel like a sandy or pebbly beach. The area under the nipple can feel like a collection of large grains. Another part might feel like a lumpy bowl of oatmeal.
It is important that you get to know the regions of your breasts. The better you know your breasts, the easier it is to tell if something has changed. You should inform your doctor if changes to your breast:
- last longer than a month
- seem to get worse or more obvious over time
How to perform a Self Breast Exam
Step 1: xThe first step is to look at your breasts in a mirror, with straight shoulders and your arms on your hips. You should look if:
- Breasts are their usual size, shape, and color.
- Breasts are evenly shaped without visible distortion or swelling.
If you see any of the following changes you should inform you doctor:
- Dimpling, puckering, or bulging of the skin.
- A nipple that has changed position or become inverted (pushed inward).
- Redness, soreness, rash, or swelling of the breasts.
Step 2 and 3
Raise your arms and look for the same changes as you did in Step 1.
While you’re at the mirror gently squeeze each nipple between your finger and thumb and check for nipple discharge (this could be a milky or yellow fluid, or even blood).
Step 4
Feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the three middle fingers of your hands, keeping the fingers flat and together; use a circular motion.
Check the entire breast from top to bottom, side to side – from your collarbone to the top of your abdomen, and from your armpit to you cleavage.
Step 5:
Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is slippery, so they like do this step in the shower. Follow the same procedures an in Step 4.
