Health Library

Categories > Family Wellness > Regular checkups and screenings

Breast cancer and young women
Early detection is critical
The genetic link
High-risk screening
What happens if you find a lump?

Breast cancer warning signs
Breast cancer warning signs

If you have any of the following symptoms, schedule a visit to your physician immediately.

  • a lump that persists throughout your menstrual cycle
  • thickening
  • swelling
  • dimpling, drawing in, or pulling in one area of the breast
  • persistent skin rash, flaking or sores near the nipple
  • scaliness
  • nipple tenderness
  • nipple discharge
  • sudden change in nipple position, such as inversion (turning around)
  • pain
  • This step-by-step guide comes from the American Cancer Society.

    Performing a breast self-exam
    Performing a breast self-exam

    The best time to perform a breast self-exam (BSE) is after your period, when breasts are not tender or swollen. If you do not have regular periods or sometimes skip a month, do the exam on the same day each month. Here’s how to properly perform a BSE:

    1. Lie down and put a pillow under your right shoulder. Place your right arm behind your head.
    2. Use the fingertips of your three middle fingers on your left hand to feel for lumps or thickening.
    3. Press firmly enough to know how your breast feels. If you’re not sure how hard to press, ask your doctor. Learn what your breast usually feels like. A firm ridge in the lower curve of each breast is normal.
    4. To help make sure that you go over the entire breast area, move around the breast in a set way. You can choose either a circular pattern, an up-and-down line pattern or a wedge pattern. It’s best to use the same exam pattern each month.
    5. Now examine your left breast using the finger pads of your right hand.
    6. It’s important to do a second exam while sitting or standing because these positions create a different distribution of breast tissue.
    7. You also should check your breasts while standing in front of a mirror. See if there are any changes in the way your breasts look, such as dimpling of the skin, changes in the nipple, redness or swelling. You might also want to do an extra exam in the shower, where soapy hands glide easily over wet skin.
    8. If you find any changes in your breasts, see your doctor right away.

    Should you get a mammogram?
    Should you get a mammogram?

    Mammograms (breast X-rays) aren’t always accurate in identifying tumors in women younger than 30 because their breast tissue is very dense, making it difficult for X-rays to flow through the breast and create a useful picture.

    As women age and breast tissue is gradually replaced by fat, mammograms become a more effective diagnostic tool.

    If you’re older than 30 and have never had a mammogram, ask your doctor whether you should have one. His or her recommendation will be based on the risk factors you have.

    Most women think breast cancer is a disease that strikes older women. That’s true, to an extent: According to the American Cancer Society, breast cancer in women 50 and older will account for 78 percent of the estimated 184,450 new cases in 2008. However, that means more than 40,000 women ages 49 and under will be diagnosed with breast cancer.

    Early detection is critical

    When they’re first diagnosed, young women with breast cancer often have more and larger tumors than older women do when their cancer is first detected. Breast cancer in younger women also tends to be more aggressive. However, most breast cancer that’s caught early and treated will be cured.

    How can you catch breast cancer early? You can improve your chances of early detection with a clinical breast examination by a health professional every three years from age 20 to 39, then annually after age 40. Also, report any changes that you find in your breasts to your doctor.

    Although mammography (taking X-rays of the breast) is an important tool for finding cancer, it doesn’t always show tumors in women younger than 30. That’s because their breast tissue is very dense, and it’s difficult for X-rays to flow through dense tissue. Your doctor will advise you when to have your first mammogram.

    The genetic link

    A woman whose mother or sister was struck by breast cancer at a young age is about twice as likely to develop the disease as other women her age who have no family history of breast cancer. In addition to family history, other risk factors include first menstrual period before age 12, first full-term pregnancy after age 30 or no pregnancies. Scientists believe that these factors increase risk because they raise a woman’s lifetime exposure to the hormone estrogen, which plays a role in breast cancer.

    High-risk screening

    Magnetic resonance imaging (MRI) scans are used in addition to mammography to screen women at very high risk for breast cancer. If you or a close relative has tested positive for the BRCA1 or BRCA2 genes or you received radiation treatment to your chest between ages 10 and 30, talk with your doctor about MRI screening beginning at age 30.

    What happens if you find a lump?

    Eight out of 10 breast lumps aren’t cancerous. If you find a lump, your doctor will examine your breasts to confirm your findings. Your doctor may suggest that you wait for a month to see if the lump disappears or changes in size during your menstrual cycle. If you’re older than 40, your doctor is likely to recommend that you have a mammogram to further evaluate the lump.

    The next step might be aspiration. In this office procedure, the doctor inserts a needle into the lump. If the lump is filled with fluid, the fluid is drawn out and the lump, or cyst, will collapse. If the fluid is clear, you’re in the clear. If it’s bloody or cloudy, it will be sent to the lab for evaluation.

    If the cyst grows back, or if the lump isn’t filled with fluid, your doctor will probably suggest biopsy. In a biopsy, all or part of the lump is removed and sent to a laboratory to see if it’s cancerous. Using special imaging equipment, the doctor can extract tiny samples of the lump with a needle or the lump can be removed through an incision.

    Many women fear that if they go in for a surgical biopsy, they may wake up to find their whole breast has been removed. Years ago, it wasn’t uncommon for surgeons to send breast lumps to pathology and wait for a verdict. If it was cancer, they would perform mastectomy. Today, however, surgeons and patients almost always choose to schedule biopsy only and wait until the full pathology report is available before making a treatment decision.