Screening for breast cancer

Last Update : 2018/12/15 23:14:13
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Radiation Oncology cancerdoctor

Hello, I am @cancerdoctor, a radiation oncologist in South Korea.


I had worked in Seoul National University Hospital in Korea, and I am working for public health now.


I am here in order to provide several important note regarding cancer.




The incidences of breast cancer are increasing recently. Most of breast cancers are detected with painless lump or diagnosed during regular checkup.


It can be accompanied with breast tenderness, skin change, blood discharge, change of breast shape, and so on when the cancer was more progressed. Some of the breast cancer patients could have palpable lymph nodes or metastatic diseases. However, if breast cancer was diagnosed with symptoms such as change of breast skin or palpable nodules in other part than breast, the stage of the disease might be above the early stage.


When investigating people diagnosed with breast cancer between 2007 and 2013 from National Cancer Institute's database, the number of patients who survived after 5 years (5-year survival rate) was like numbers below.



Stage I: nearly 100%


Stage II: 93%


Stage III: 72%


Stage IV: 22%



Namely, breast cancers are able to be cured if they are detected in early stage. Stage I is defined as tumor less than 2cm without lymph node metastasis. Therefore, it is very important to detect a tumor quickly when size is still small and treat it earlier.


breast exam.jpg


The patients who are diagnosed at the initiatory stage present with a painless breast mass or have an abnormal screening mammogram. Is it easy to perceive a mass of 1-2cm in my breast? Do you sometimes observe your breasts closely and test them with your hand?




1. Breast self-screening method


It is recommended to perform a breast self-screening once a month, in 3 to 5 days after the end of menstruation. I usually recommend to perform a self hand test during a shower. Please see below for more details about self-screening method. This is from "A white paper on breast cancer" written by Korean Breast Cancer Society.



Step 1: Watching with your eyes from the mirror.
self1.png



  1. Observe both breasts with putting your arms down.

  2. Raise both hands to the back of the head, and push out the chest forward.

  3. Put your hands on your waist, push your shoulders and elbows forward, and give strength to your chest and lean forward.



** Remember the usual shape of your breasts.



Step 2: Palpation standing or sitting.
self2.png



  1. Lift your arm above your head and examine using the second, third, and fourth fingers on the opposite side.

  2. Draw a circle from the outer upper part of the breast to the inside. Check the upper and lower parts of the collarbone and under the armpit.

  3. After checking around the nipple with a small circle, squeeze the nipple up and down from both side to the inside and check for abnormal secretions.



** Use palmar side of your fingers, not fingertips.



Step 3: Palpation lying down.
self3.png



  1. Lie down in a relaxed state. Fold a towel under the test side of the shoulder. Raise the test side of the arm and check with the other side of your hand like in step 2.





2. Mammogram


In Korea, it is recommended to take a mammogram annually over age 40. Mammogram is a simple test examining breasts using x-ray. Large clinical studies had been performed to investigate the effect of the test, in the US and Europe since 1970s, and reported that the breast cancer mortality in groups receiving screening test decreased for around 20 to 40%.


Mammogram.png




If you perform a regular checkup that includes breast self-screening and regular mammography, we can prevent the cancer from being diagnosed at more advanced stages, and avoid missing the timing of being cured.




Reference



  1. Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2014, National Cancer Institute. Accesible at https://seer.cancer.gov/csr/1975_2014/

  2. Korean Breast Cancer Society. A white paper on breast cancer. 2013.

  3. Ingvar Andersson et al., Mammographic Screening and Mortality from Breast Cancer: The Malmo Mammgraphic Screening Trial. British Medical Journal, 1988. 6654:943-48.

  4. Image of mammogram: https://commons.wikimedia.org/wiki/File:Blausen0628Mammogram


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