Breast Cancer Awareness: Breast Self Exams and Mammograms and Breast Self Exam

Regular breast self exams and routine mammograms are two of the most important steps we can take for good breast health. You don't have to like them, but you should do both before having your surgery, especially if you are 35 or over, have a history of breast cancer in your family, or if you just want to know that your breasts are clear of any problem. A self breast exam should be part of every woman's monthly routine.

Women generally do not need to have their first mammogram until age 40 unless breast cancer runs in the family. However, a mammogram is often recommended before breast reduction surgery for women who are 35 and over, followed by a post-op procedure at the 3 to 6 month mark to be used as a baseline for future mammograms.

We will discuss the different types of mammograms as well as x-rays and Magnetic Resonance Imaging (MRI). I will also show you some photos you don't want to see and some that you should see, and I've included a diagram to help you visualize the correct way to perform a monthly breast self exam. This is very important. Your life may depend upon it!

Frequently Asked Questions

Why get a mammogram?

Because it could save your life! Seriously. According to the American Cancer Society, despite advanced technology and increased awareness, breast cancer remains the #2 cause of cancer-related deaths in women. Regular mammograms put your mind at ease and alert you to possible tumors, cysts and calcifications that may need to be biopsied.

Mammograms can detect lesions well before you or your doctor can feel a lump. The goal of screening exams like mammograms is to find cancers before they start to cause symptoms. Breast cancers found during a self exam tend to be larger and are more likely to have already spread beyond the breast, according to ACS, while those found during screening exams are more likely to be small and still confined to the breast. The size of a breast cancer and how far it has spread are important factors in predicting the prognosis of a woman with this disease.

How often should I get a mammogram?

Women age 40 and older should have a screening mammogram every year and continue to do so for as long as they are in good health.

How does a mammogram work?

A mammogram is a special type of low-dose x-ray designed to specifically screen breasts for cysts, cancerous and non-cancerous lesions and lumps. Breast x-rays have been around since the 1920's, but modern mammography has only existed since 1969.

Can I get cancer from a mammogram?

Strict guidelines ensure that mammogram equipment uses the lowest dose of radiation possible to make high-resolution (very detailed) images of your breast tissues.

Radiation is measured in rads. To give you an idea of just how low a dose mammography delivers, the dose for each view (individual x-ray shots) is between 0.1 and 0.2 rads. By comparison, a woman with breast cancer who undergoes radiation treatment will receive around 5,000 rads. The ACS notes that if a woman has yearly mammograms beginning at age 40 and continuing until she's 90, she will receive between 20 and 40 rads total.

If you have breast implants, you will need several different views per breast instead of the average 2 views per breast. This translates into increased rads compared to an unaugmented patient. Be sure that your chosen clinic is accredited by the American College of Radiology (ACR) to assure the highest quality of mammography equipment and technicians.

Does having a mammogram hurt?

For a mammogram, the breast is compressed between 2 plates to flatten and spread the tissue to produce a good, "readable" mammogram. Many women report that they feel awkward, uncomfortable and perhaps a little violated during the mammogram, but you should experience no real pain. However, if you should have sharp pains or intolerable discomfort, tell the technician right away so that she can reposition you. Also let her know if there is an underlying cause that may be adding to your discomfort (i.e., if your breasts are tender because of where you are in your menstrual cycle.)

The biggest fear most women have about mammograms is the compression factor. The technician must immobilize your breast to get a proper view and to reduce any blurring. The compression lasts only a few seconds. Some women report the cessation of caffeine intake helps decrease discomfort significantly.

Can I just remove my shirt for the exam?

Yes, in most clinics you are only asked to remove your top, so dress accordingly. Wearing pants or a skirt will save you from having to completely undress.

How long does having a mammogram last?

The whole process includes undressing, positioning and views. The actual views (when the pictures are taken) should last no more than a few seconds. The entire appointment should take no more than a half-hour if you have implants, or 15 to 20 minutes for un-augmented patients.

How will I know an irregularity is found?

Normally, the clinic or your doctor will contact you within two weeks with the results of your mammogram. However, this does not mean that you should forget about it if you don't hear from them. This is your life on the line, so pick up the phone and call them! They usually say "no news is good news", but is it worth the risk?

What happens if I find out I have an irregularity?

An irregular outcome usually means more in-depth views, examinations and biopsies. "Biopsy" is a scary word. It means they will remove a cyst, lump, or lesion from your breast, which means more waiting on your part. If there is a problem, you will be counseled and directed to more tests.

What NOT to do before your mammogram...

Do not wear and lotions, talcum powder (talc), perfumes, sprays, deodorant, etc. These substances may cause speckles and spots to show up on your mammogram.

How to Perform a Monthly Breast Self Exam

The best time to perform a breast self exam (if you are still menstruating) is about 3 days after the last day of your period. The breasts normally swell and can develop typical lumpiness when you are ovulating (about 14 days after your period ends) and again when you're premenstrual. If you wait until the 3 day mark, your breasts are less likely to be swollen or tender.

If you are post-menopausal, you should pick a time of the month that is most convenient to you and stick with it, examining your breasts the same day each month to compare variances from exam to exam.

Stand in front of a mirror with your hands pressing firmly down on your hips, which contracts the chest wall muscles and makes any breast changes more obvious. Look for anything out of the ordinary on your breasts — changes in size or color, contour or dimpling, or redness of scaliness of the nipple or breast skin. Raise each arm separately and slightly to check for any changes between when your arm is at your side and when it's raised. Examine each underarm, noting any odd sensations and writing them down, if necessary.

Next, lie down on a firm bed or floor, completely flat, so your breast tissue, glands and fat cells spread out to the sides more easily. This is especially helpful when one has breast implants. To begin, raise either arm over your head and use the pads of your three middle fingers of the opposite hand to feel for lumps in the breast. Use overlapping dime-sized circular motions and 3 different levels of pressure to examine your breast: light pressure to feel the tissue closest to the skin, medium pressure to feel a little deeper and firm pressure to feel the tissue closest to the chest and ribs. A firm ridge in the lower curve of each breast is normal.

Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Check the entire breast area between the ribs and collarbone, or clavicle. Repeat the exam on your other breast.

Take note of any discharge, changes in contour, color, lumps, firmness, pressure sensitivity or anything else you find odd and report them to your physician immediately. Early detection of possible tumors, calcifications, cysts, etc. is the best way to get a jump on breast cancer. You may find it helpful to keep a journal for your breast self exams so you can make comparisons from month to month and as a reference should the need ever arise for you to discuss any abnormalities with your physician. Remember: it's best to perform your breast self exams at the same time each month.

Your breast self exam may take a few minutes the first time you do it, but you will gain confidence and speed as you get accustomed to it.

Breast Self-examination Pamphlet From The American Cancer Society

Click on any graphic for a larger image.

Magnetic Resonance Imaging (MRI)

For some women who are at high risk for breast cancer, a screening MRI is recommended along with a yearly mammogram. MRI uses magnets and radio waves instead of x-rays to produce very detailed, cross-sectional images of the body. It requires special equipment, and higher quality images are produced by dedicated breast MRI equipment than by machines designed for MRI scanning of other parts of the body, including the head, chest or abdomen.

The Least You Need to Know

  • Early detection of possible tumors, calcifications, cysts, etc. is the best way to defeat breast cancer.

  • Perform a breast self exam every month, 3 days after the last day of your period. It is helpful to keep a journal of your findings to discuss with your physician should any abnormalities surface.

  • If you are 35 and over, you should be instructed by your surgeon preoperatively to obtain a mammogram and report before any breast procedure is performed.

  • Mammograms are usually started at 40 years of age and continue annually.