March 2011

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When should I self-exam or get a mammogram?

This depends on two things: how old you are and what your risk category is for breast cancer.

First, look at this diagram of the order of breast cancer detection:



Detection can start by you finding the symptom, or your doctor finding the symptom, or a radiologist finding the symptom.

When should I get a mammogram?

For women under the age of 40, who are at an average risk for breast cancer, mammograms usually don’t work very well. This is because your breast tissue is dense, making it difficult for cancerous spots to show up on the x-ray. However, if you do find a symptom that needs examined further you have other options—such as getting an MRI, or using an ultrasound to investigate a specific area on the breast.

TIP: Mammograms feel a lot like getting your blood pressure taken. If you are menstruating, it’s best to schedule your mammogram away from your period when your breasts aren’t so tender. This can help a lot!

For women over the age of 40, how often you should get a mammogram depends on your local recommendations. For example, in the UK women are told to get a mammogram every 3 years from age 50+. In the USA, women are told to get a mammogram every year, to every other year from age 40+.

Why are breast cancer recommendations not the same in every country? —>

There are a few reasons for this. One reason is that the more mammograms a woman gets, the more likely they are to find something suspicious and get it biopsied. 80% of biopsies are not cancerous and some people think that it causes too much stress and results in unnecessary procedures. However, you can’t know if it is cancer or not until the cells are looked at under a microscope.

On the other hand, by having several mammograms to compare, it makes it easier for the radiologist to spot a change earlier. And, as mammograms can detect breast cancer before it can be felt, mammograms are an important part of detection. So some argue that the more mammograms the better, as when breast cancer is caught early, the cure rate is over 95%.

Another factor is the availability of resources. If women were asked to be screened every month from the age of 12, it would place a large burden on the healthcare system which may impact on other areas. For example, would the radiologist be spending too much time on routine screening mammograms, when they also need to spend time reading mammograms of people who have presented symptoms? Are there other health issues that need funding and attention? Each country looks at these factors and weights the risks differently. This is why there are so many different recommendations.

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How will I know if I have a sign of breast cancer?

Most of the time breast cancer presents as a lump, which feels a lot like a lemon seed—hard and immovable. This is different from the normal bumps in your breast which can feel like soft peas, or lymph nodes that feel like soft lima beans.

This poster explains what you need to know when doing a breast exam which is: what is located where AND what it should or shouldn't feel like.

Sometimes breast cancer can be seen, such as a change in shape, an inverted nipple, unusual fluid or a rash-like red skin (in fact there are a dozen signs). Most of the time these physical changes are harmless, such as an infection or hormonal change. But if something persists, it’s important to show a doctor.

This poster answers the question, "What does breast cancer look like?" If you see something new like this that stays around, show your doctor and investigate why.

The best time to detect breast cancer is when it can’t be seen or felt. This requires technology, such as a mammogram, ultrasound or MRI. Your age and risk type will determine which option is best for you.

Between your regular appointments, it’s a good idea to be aware of what is normal for you, so if something changes you can recognize it and tell your doctor.

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screening plan

There are two important people when it comes to detecting breast cancer—you and your doctor.

But sometimes it can be intimidating to ask questions, sometimes we don’t even know what to ask, or how to ask it.

This is where the Risk Assessment Form does all of the hard work for you. Just download, print and bring it with you to your next appointment. Together, you and your doctor can discuss your family history and other risk factors for breast cancer. Then, knowing if you are normal or high risk, a screening plan can be made and you can decide together how often you should get a mammogram, or at what age to begin.

It’s a simple way to get the conversation started, and can also be copied for your patient chart.

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