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Breast Cancer Screening :

Breast cancer screening is the medical screening of asymptomatic, apparently healthy women for breast cancer in an attempt to achieve an earlier diagnosis. The assumption is that early detection will improve outcomes. A number of screening tests have been employed, including clinical and self breast exams, mammography, genetic screening, ultrasound, and magnetic resonance imaging.

There are mainly Three types of tests used for Breast Cancer Screening as :

1.1 Breast Self Examination (BSE) :

Breast self-examination (BSE) is a screening method used in an attempt to detect early breast cancer. The method involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling.

  • Opportunity for woman to become familiar with her breasts
  • Monthly exam of the breasts and underarm area
  • May discover any changes early
  • Begin at age 20, continue monthly

Breast Self Exam Information :

  • It is easy to do and the more you do it, the better you will get at it.
  • When you get to know how your breasts normally feel, you will quickly be able to feel any change, and early detection is the key to successful treatment.
  • Most breast lumps are found by women themselves, but in fact, most lumps in the breast are not cancer.
  • The best time to do breast self-exam is right after your period, when breasts are not tender or swollen. If you do not have regular periods or sometimes skip a month, do it on the same day every month.

When to do a self Breast Exam :

The best time to do breast self-exam is right after your period, when breasts are not tender or swollen. If you do not have regular periods or sometimes skip a month, do it on the same day every month.

There are two parts to the BSE :

  • Looking
  • Feeling

Looking :

Looking in Mirror


Change in Skin color, Size

Skin Dimpling

Changes in Nipple

Nipple Discharge

Lump :

  • Any new lump or hard knot found in the breast or armpit
  • Any new lump or thickening that does not shrink or lessen after your next period

Change in Skin color, Size :

  • Any change in size, shape or symmetry of your breast
  • Any thickening or swelling of the breast

Skin Dimpling :

  • Any dimpling, puckering or indention in the breast
  • Dimpling, skin irritation or other change in the breast skin or nipple

Changes in Nipple :

  • Redness or scaliness of the nipple or breast skin
  • Nipple tenderness or pain
  • Nipple retraction; turning or drawing inward or pointing in a new direction

Nipple Discharge :

  • Any fluid coming from your nipples other than breast milk, particularly if the discharge is bloody, clear and sticky, dark or occurs without squeezing your nipple

Feeling :

  • Examine each breast separately.
  • Use pads of fingers not the tips.
  • Examine the armpits.

Finger Use :

  • Use the pads of your middle three fingers to feel the texture of your breast
  • Your finger pads are the top third of each finger, not the tips

Patterns :

  • Up / Down
  • Circular
  • Wedge

When using any of the 3 patterns, you should always be using a circular rubbing motion (in dime-sized circles) without lifting up your fingers.

1.2. Clinical breast examination (CBE) :

A Clinical Breast Examination (CBE) is a physical examination of the breast done by a health professional. Clinical breast examinations are used along with mammograms to check women for breast cancer.

A Clinical Breast Examination may be part of your regular checkup. Talk with your health professional about how often you need a breast examination. Women with breast implants should also have regular clinical breast examinations.

  • Performed by doctor or trained nurse practitioner
  • Annually for women over 40
  • At least every 3 years for women between 20 and 40
  • More frequent examination for high risk patients

The Procedure :

  • Explain what you will be doing
  • Ask if she does breast self exam
  • Warm your hands
  • Assure privacy
  • Would someone else in the room be helpful?
  • Assist patient to supine position

Palpation :

Variables important in palpating the breast correctly are :

  • patient position
  • breast boundaries
  • examination pattern
  • finger position, movement, and pressure
  • duration of the examination

1. Patient Position :

Patient's Positions required during examination are :

  • Clinical breast examination requires flattening breast tissue against the patient's chest
  • Patient is supine during the examination

2. Breast Boundaries :

  • Breast tissue extends laterally toward the axilla and superiorly toward the clavicle
  • Cover a rectangular area bordered by the clavicle superiorly, the midsternum medially, the midaxillary line laterally, and line passing through xiphisternum inferiorly

3. Examination Pattern :

  • Palpation begins in the axilla and extends in a straight line down the midaxillary line to the inferior axis line
  • The fingers move medially, and palpation continues up the chest in a straight line to the clavicle
  • Rows should be overlapping

4. Technique :

  • The 3 middle fingers are held together, with the metacarpal-phalangeal joint slightly flexed
  • Pads of the fingers are the examining surface
  • Each area is palpated by making small circles using 3 different pressures-light, medium, and deep

5. Duration :

  • 3 minutes recommended for each breast
  • Average actual time spent is 1.8 minutes
  • Discuss with patients the time needed to do a complete examination and discuss the procedure during the examination

1.3. Mammography :

Mammography is the process of using low-energy X-rays (usually around 30 kVp) to examine the human breast, which is used as a diagnostic and screening tool. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses and/or microcalcifications.

Mammograms use doses of ionizing radiation to create images. Radiologists then analyze the images for any abnormal findings. It is normal to use lower-energy X-rays (typically Mo-K) than those used for radiography of bones.

  • A screening mammogram is an x-ray examination of the breast in a woman who has no symptoms.
  • The goal of a screening mammogram is to find cancer when it is still too small to be felt by a woman or her doctor.
  • Effective in women above age of 50 yrs.
  • Based on fair evidence, screening mammography in women aged 40 to 70 years decreases breast cancer mortality.
  • The benefit is higher for older women, in part because their breast cancer risk is higher.
  • Women (asymptomatic) 40 years of age and older should have a mammogram every year.

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