How To Screen Yourself Early for Breast Cancer *Viewer Discretion Advised*

Dear Dr. Deena,
I am 22 years old, and am concerned about my risk for breast cancer. I don't have a family history, but I hear how prevalent this is among women. Is there anything I can do to screen myself (I think I am too young for a mammogram). 
Thanks.
Jamie

Thanks for a wonderful question, Jamie. I am so proud of you in that you are really concerned about prevention at a young age! 

Breast cancer is the 2nd leading cause of cancer-related deaths in women, after lung cancer. According to the National Cancer Institute, "about 39,520 women in the U.S. were expected to die in 2011 from breast cancer, though death rates have been decreasing since 1990 — especially in women under 50. These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness."

Luckily some breast cancers may be detected early with a self-examination of the breast. Clinical data has shown that up to 40% of breast cancers are detected when women feel a lump on examination.

Make sure you perform the breast examination once a month, so that you get comfortable with what your breast normally feels like. This will make you more aware of what is normal for you.

Feeling a lump, bumpy tissue or tenderness in the breast before or during your period is quite common as the consistency of your breast tissue changes during this time due to hormones...this is why I recommend performing the self-examination AFTER you have completed your period.

Below are some easy steps that you can follow to screen yourself for breast cancer. If you are still confused, you can find videos on self-breast examinations with a quick internet search or on Youtube.

You can practice the breast exam in the shower, in front of a mirror, or lying down. Whichever you choose - I would recommend using the same position every time you repeat the examination.

Now that you know when and how often to perform the self breast exam...let's begin!

1st Step is INSPECTION:

1. Look at your breasts in the mirror 
Are your breasts the usual size and shape? (it is normal for one breast to be bigger than the other, you should mainly be concerned if something has changed over time)
Do you notice any redness anywhere?
Does your skin look smooth? Is there any dimpling? Are there any skin changes that look new?
Do you see any abnormal lumps? 


2. Look at your nipples in the mirror
Do the shape and size of your nipples look any different to you? 
Does the color and texture of your nipples feel the same to you?
Do you notice any blood or dry discharge from the nipple?

3. Now  raise your arms above your head (see image below) and repeat steps 1 and 2.

(Image courtesy of breastcancer.org)

Do you notice any of the above changes again with your breasts or nipples?

2nd Step is EXAMINATION:

**If you decide to perform the exam lying down - rest your head on a pillow and make sure to put the hand under your head like this:

(Image courtesy of breastcancer.org)

Perform the breast examination with the following steps: 

(Courtesy of B4bc.org)

If you notice something abnormal, be sure to contact your physician right away. 8 out of 10 lumps are completely benign (normal), but it is necessary to get further evaluation for diagnosis and to put your mind at ease!

Here are some photos of what is abnormal when inspecting your breasts, which should alert you to get more medical attention: 

(Viewer discretion advised)

--When inspecting the size and shape of your breast, it should normally be round all over. Any areas where the skin is pulled in (called "Dimpling") may be abnormal. Here is a photo of "dimpling" in the right breast (Circled in red):

(Image courtesy of www.dailyrecord.co.uk)

--Skin that looks red and inflamed is abnormal. Physicians call this "peau d'orange" because it looks like an orange peel: 

-- Ulcerations (areas of skin breakdown) or nodules (large lumps at the surface of the skin) are always abnormal. The patient below has both nodules and ulcerations of the left breast tissue:

(Courtesy of http://upload.wikimedia.org/wikipedia/commons/8/83/RecurrentbreastCA.gif)

--Inversion or retraction of the nipple is another abnormality to be aware of:

--Discharge from the nipple when you squeeze it (blood, milky discharge, pus, etc.) is abnormal:

--When performing the breast exam it is important to be aware of scaling of the nipple skin, bumps on the nipple, or any skin changes of the nipple as demonstrated in this image:

(Courtesy of carcinogenesis.com)

Nipples can sometimes become dry or irritated from clothing, and might appear scaly. For dry nipples, try using a small amount of moisturizing lotion to the affected area. If the skin remains the same despite moisturizing - you should be evaluated by a physician. 

I cannot reiterate enough that if you have any of the above findings, you should see a physician as soon as possible!!

Also -if you are over the Age of 40 OR younger than the Age of 40 (males included) with risk factors for breast cancer (such as a strong family history or carrying a known mutation of the BRCA1 or BRCA2 gene) you should consult with an MD on getting a mammogram. Mammograms detect breast cancers that you cannot see or feel on examination.

I hope this helps in your early screening for breast cancer! I wish you all the best of luck as you attempt to take control of your health through prevention.

Please continue to email all questions to: DoctorDeenaMD@gmail.com

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**