Early detection of breast cancer can lead to greater likelihood of cure. The American Cancer Society recommends the following guidelines for the detection of breast cancer in women who are asymptomatic (show no symptoms of breast cancer):

• Women 20 years of age and older should women should be told about the benefits and limitations of breast self-exams (BSE). Women should be aware of how their breasts normally feel and report any new breast change to a health professional as soon as they are found. [Note: while the American Cancer Society recently amended its guidelines and no longer recommends monthly BSE, many healthcare professionals believe strongly in this easy, no cost method of screening for breast cancer and continue to recommend BSE on a monthly basis].
• Women 20-39 should have a physical examination of the breast (CBE or clinical breast exam) at least every three years, performed by health care professional such as a physician, physician assistant, nurse or nurse practitioner. CBE may often be received in the same appointment as a Pap smear. Women 20-39 should also perform monthly BSE.
• Women 40 and older should have a physical examination of the breast (CBE or clinical breast exam) every year, performed by a health care professional, such as a physician, physician assistant, nurse or nurse practitioner. CBE can often be performed in the same visit as a mammogram. Monthly BSE should also be performed.
• Women 40 years of age should receive a screening mammogram every year. The National Cancer Institute recommends mammography every one to two years for women between 40-50 years of age. Beginning at age 50, screening mammography should be performed every year.

Women with a high risk of breast cancer and/or family history of breast cancer are encouraged to consult their doctor or other trained medical professional about receiving annual screening mammograms starting between the ages of 30 and 40. Woman at a very high risk of breast cancer (such as those tested positive for the BRCA1 and BRCA2 breast cancer genes) should speak with their physician about beginning annual mammograms as early as age 25.

Breast self-examination (BSE) is a visual and manual examination of the breast that can be easily carried out by women on a monthly basis. While breast self exams have not been shown to increase the chances of surviving cancer, BSE helps women familiarize themselves with the characteristics of their breasts. Done regularly, the exam has been shown to permits the detection of some early changes and small lumps in the breast in some women. A woman who discovers a lump in her breast should report it to her doctor immediately. Some healthcare professionals recommend that women begin BSE in their teens, after they have gone through puberty and have begun regular menstrual cycles. Click here for detailed information on breast self exam.

Clinical Breast Examination (CBE)

A clinical breast examination (CBE) is a physical examination of your breasts by a trained medical or health professional, such as a physician, nurse practitioner, nurse, or physician’s assistant. CBE includes inspection (looking) and palpation (feeling) of the entire breast/chest area including the lymph node areas above and below the collarbone and under each arm. Women should discuss breast-self examination techniques and personal findings with the healthcare professional performing their CBE. Women should also use the CBE session as an opportunity to learn how to correctly perform breast self-exam.

For the CBE examination, the patient undresses from the waist up. Using the pads of the fingers, the examiner will gently palpate (feel) each breast. Special attention will be given to the shape and texture of the breasts, location of any lumps, and whether such lumps are attached to the skin or to deeper tissues. The armpits and areas under both arms will also be examined.

A small percentage of breast cancers are not detected by mammography but can be felt during a clinical breast examination. Therefore it is important that a woman have both her mammogram and clinical breast exam done in the same month.

The earliest sign of breast cancer is usually an abnormality that shows up on an annual mammogram before a woman or her health care provider can feel it. The National Cancer Institute estimates that mammography can often detect very small cancers up to two years before it can be discovered by physical exam.

Breast Changes and Warning Signs To Watch For With Breast Self-Exam:

• Any new lump found in the breast or armpit
• Any lump or thickening that does not shrink or lessen after your next period
• Any change in the size, shape or symmetry of your breast
• A thickening or swelling of the breast
• Any dimpling, puckering or indention in the breast
• Dimpling, skin irritation or other change in the breast skin or nipple
• Redness or scaliness of the nipple or breast skin
• Nipple discharge (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
• Nipple tenderness or pain
• Nipple retraction: turning or drawing inward or pointing in a new direction
• Any breast change that may be cause for concern

What If I Feel a Lump?

See or contact your doctor immediately if you find a lump or any other change in your breast. The vast majority of breast lumps found by self-examination (80%) are determined to be non-cancerous (benign). Many are fluid-filled cysts that can be easily drained or left alone. Many women have naturally fibrous breasts that feel lumpy. Although this is normal, women with lumpy breast must be diligent about self-examinations. Even if a woman has a normal mammogram, all persistent lumps should be re-evaluated at the proper interval.

Comparing Different Breast Exams

Size of Tumors Found by Mammography and Breast Self-Exam
	Average-size lump detected with routine mammogram (0.43 inches / 1.1 cm)
	Average-size lump detected with first mammogram (0.59 inches / 1.5 cm)
	Average-size lump found by regularly practicing breast self-exam (0.83 inches / 2.1 cm)
	Average-size lump found accidentally (1.42 inches / 3.6 cm)

* These images were created for viewing at 800 by 600 resolution on a 16-inch monitor. They will appear larger or smaller depending upon display size and resolution. However, the relative size of the detected tumor will remain consistent.

Click Here to Learn More About Breast Self-exam

Return to the Main Menu for Breast Health

Updated: November 8, 2007