How Do I Know if I Have Breast Cancer?

The most effective way to detect breast cancer is by mammography, along with regular breast exams by your health care provider. But medical organizations don't agree on the recommendation for breast self-exams, which is an option for women starting in their 20s. Doctors should discuss the benefits and limitations of breast self-exams with their patients.

Breast Self-Exam

If you decide to do breast self-exam, make sure to go over how to perform it with your health care provider. Premenstrual changes can cause temporary thickening that disappears after the period, so it may better to check your breasts three to five days after your period ends. If a breast self-exam makes you anxious or you have questions about how to perform it, consult your health care provider.

Look for dimpling or changes in shape or symmetry. This may be best done by looking in a mirror. The rest of the breast self-exam is easiest in the shower, using soap to smooth your skin. Using light pressure, you should check for lumps near the surface. Use firm pressure to explore deeper tissues. Squeeze each nipple gently; if there is any discharge -- especially if it is bloody -- see your doctor.

Any time you find a new or unusual lump in your breast, have your doctor check it to make sure it is not cancerous or precancerous. Most lumps are benign and do not signal cancer. The best test for distinguishing a cyst from a solid tumor is ultrasound; a needle biopsy may also be done. Have your breasts examined by a health care provider once every three years starting at age 20, and every year after age 40.

The American Cancer Society recommends yearly screening mammograms starting at age 40. However, the U.S. Preventive Services Task Force (USPSTF) does not recommend screening for women in their 40s. For women between the ages of 50 and 74, USPSTF experts say, women should have mammograms every two years. When you need a mammogram is a personal decision between you and your doctor. If you're over 40, talk to your doctor about when you should begin mammogram screening. Breast lumps can be identified on a mammogram up to two years before they can be felt.

Several tests can help distinguish a benign (noncancerous) lump from a malignant (cancerous) tumor. Because malignant and benign lumps tend to have different physical features, imaging tests such as mammography and ultrasonography can often rule out cancer. The only way to confirm cancer is to perform a needle aspiration or a biopsy and to test the tissue sample for cancer cells.

If a lump is found to be malignant, you and your doctor need to know how advanced the cancer is. Various tests are used to check for the presence and likely sites of spread, or metastasis. Cancer cells can be analyzed for the presence or absence of hormone receptors, and the Her-2 oncogene, to find out if the cancer is likely to respond well to hormone therapy, as well as to determine the benefits of anti-Her-2 therapy. Other tests can help predict the likelihood of metastasis and the potential for recurrence after treatment.