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Detection and Diagnosis

In pre-menopausal women, breast cancer is most commonly detected when a woman or her doctor feels an abnormality in her breast by an examination of the breasts by hand. In post-menopausal women, breast cancer is most often detected by a doctor with the help of a mammogram rather than by the examination of the breast by hand. Breast cancer diagnosis is the process of identifying and evaluating a suspicious breast symptom, such as a lump, abscess or nipple discharge. The most common methods currently being used for diagnosing breast cancer are diagnostic mammography, ultrasound and biopsy.

Clinical Breast Examination (C.B.E.)
Clinical breast examination is similar to a breast self-exam, except that a clinical breast exam is a routine examination of a woman's breasts by a doctor or other medical professional in a medical environment. The elements of a clinical breast exam are visual observation and palpation (examination of the breast by hand), It is recommended that a woman verify that her doctor is trained in breast problems or breast cancer.

Advantages
A trained breast specialist may find a suspicious lump that may have been undetected by a woman’s self-examination.

Limitations
Clinical breast exam produces subjective results. If a suspicious lesion is found, the woman may be subjected to painful diagnostic testing often resulting in a benign finding.

Mammography
Mammography is the process of emitting a low-dose X-ray beam through a portion of the breast while the breast is compressed between a plastic paddle and a film holder. The result is a black and white negative displaying the fatty tissue, the ducts and lobes within the breast and possibly an abnormality. Mammography is classified in two categories: screening mammography and diagnostic mammography. Screening mammography usually involves taking two pictures of each breast, one in a lateral position, the other vertical, and includes all healthy women. The American Cancer Society recommends that women 40 years and over get a mammogram once a year. The National Cancer Institute recommends that women over 50 have annual mammograms. Women under 50 should talk with their doctor about the pros and cons of screening mammography then decide for themselves whether to undergo the procedure.

Advantages
Mammography may detect very small, non-palpable lesions that could be benign or malignant. Mammograms can pick up pre-cancers in certain areas. Clinical trials in screening mammography have shown a reduction in mortality from breast cancer by 30 percent in women between the ages of 50 and 69.

Limitations
Mammography is subject to interpretation. One clinical test revealed that 10 radiologists who reviewed the same set of 150 mammograms gave significantly different diagnoses. Cancer may no be visible in women with dense breast tissue. A cancer growing near the chest wall may not be detectable on a mammogram. An average of 10 to 15 percent of tumors may not be detectable on a mammogram. This average is higher in younger women. Mammography exposes a woman to radiation. Mammograms are not as effective for women with breast implants.