Screening /early detection of breast cancer reduces the mortality (death rate) from the disease. Numerous mass screening programs have been conducted.

Techniques used for early detection of breast cancer include:

a) Physical examination (Palpation) by a physician.

a) Breast self examination (BSE).

c) Imaging. Eg Mammography, thermography etc.

Screening programs identify about 10 cases of breast cancer out of 1000 women older than 50 years of age and 2 cases of breast cancer out of 1000 women who are younger than age 50 years.

Up to 80% of cases of breast cancer have negative (uninvolved) axillary lymph nodes at the time of surgery. In routine clinical practice (without screening) only about 50% have uninvolved axillary nodes. Therefore this can lead to a large increase in the chance of survival (up to 85% of women who are screened and found to have breast cancer will survive at least five years).

For an optimal screening program both physical examination (By a physician) and mammography are necessary. 35 to 50% of early breast cancers can be discovered only by mammography while another 40% can be detected only by palpation. One third of abnormalities detected by screening mammograms will be found to be malignant when biopsy is performed.

It must be noted that the beneficial effects of screening in women aged 50-69 years is undisputed. It has been conformed in all clinical trials. The beneficial effects of screening among age group 40-49 is very small.

Physical Examination (Palpation) by a physician

Breast examinations should be performed by a physician as part of a routine medical care. This serves as an effective screening process.

The frequency of such examinations should be as follows:

a) Women aged over 40 years- Should have yearly breast examinations.

b) Women aged 20-40- years, should have breast examinations every 2-3 years.

Breast Self Examination (BSE)

Most breast cancers are found by women themselves rather than by the physician. Therefore it is advisable for all women to perform self examination.

Breast self examination (BSE) has not been shown to improve survival. But it is still encouraged because in many countries BSE is probably the only method of screening that can be done, due to financial constraints. BSE also increases the biopsy rate.

Due to the absence of evidence supporting the value of BSE, the American Cancer Society no longer recommends monthly BSE, from the age of 20 years. However women should be informed of the potential benefits, harm (such as false positive results and increased rates of biopsy) and limitations associated with breast self examination.

Technique of Breast Self Examination (BSE)

The proper technique of breast self examination should be demonstrated (either practically or by using charts) to women who choose to perform BSE.

In premenopausal women (women who have not yet attained menopause), BSE should be done about 8 days after the menstrual period.

Inspection: The breast must first be inspected on a mirror, with both hands by the sides, overhead and then firmly pressed  on the hips to contract the pectoralis major muscles.

During inspection asymmetry, masses and dimpling of the skin should be noted.These may also become more apparent with the above maneuvers.

Palpation: After inspection (see above) each breast should be palpated carefully by the fingers of the opposite hand. It is thought that small breast lumps are felt more readily when the skin is moist (such as while bathing or showering).

The use of Imaging (including mammography)  in Breast Screening will be covered in the next post (Please see related links below)

References:

Page 290, Chapter 6. Epidemiology of Chronic Non- communicable Diseases and Conditions. Park’s Textbook of Preventive and Social Medicine by K. Park. 17th Edition.

Pages 707 to 709, Early Detection of Breast Cancer. Chapter 16 Breast. Current Medical Diagnosis and Treatment 2006.Edited by Lawrence M. Tierney,Jr. Stephen J. McPhee Maxine A. Papadakis.

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