Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

How can I find breast cancer early?

The best way to find breast lumps that may be cancer is to do two things:

1. Have regular mammograms.
2. Have your doctor check your breasts every year.

Doing both gives you the best chance to find cancer as early as you can. Finding breast cancer early makes treatment much easier and more effective.

Breast cancer incidence increases with age and the rate is lower in women under 40. A few women with risk factors such as a history of 2 or more family members having breast or ovarian cancer under age 40 may also have the disease at a younger age. Your family doctor can determine if you need a test for the BRCA gene which runs in these families.

What is a mammogram?

A mammogram is the most effective way to find breast cancer early, up to two years before the lump is even large enough to feel. A mammogram is a special kind of x-ray of your breasts. A radiologist will look at the x-rays for signs of cancer or other breast problems. Mammograms can detect cancer because cancer is denser (thicker) than the normal part of the breast. Mammograms are safe because the amount of radiation used in the x-ray is very small.

How is a mammogram performed?

Your breast will rest on a shelf and the x-ray machine will be slowly pressed against your breast until you feel pressure. This pressure is needed to spread your breast out so that a better x-ray can be taken. The pressure is just for a moment while each picture is taken.

Do mammograms hurt?

Mammograms can be uncomfortable. To get a good picture, the breast has to be squeezed, but they don't take very long.

How often should I get a mammogram?

If you're over 50, get a mammogram and have your breast examined by your family doctor on a regular basis, usually every 1 to 2 years. If you have risk factors for breast cancer, such as a family history of breast cancer, your doctor may want you to have mammograms more often or start having them sooner.

How often should my doctor check my breasts?

You should have a breast exam in addition to a mammogram every 1 to 2 years beginning when you're 50. Talk with your doctor if you are under 50 and have a family history of breast cancer. He/She may examine you more often or sooner after discussing your risk factors.

How often should I examine my breasts?

There is data that tells us now that breast self-exam may not help. You can get used to how your breasts normally feel, so you're able to tell if a new lump has appeared but you don't need to do a breast self-exam every month.

How is a breast exam done?

The doctor starts by standing in front of you. Looking at your breasts with your arms at your side, with your arms raised behind your head, and with your arms on your hips with your chest muscles flexed will help the doctor see any lumps.

You will then be asked to lie down. Put your arms by your sides. The doctor will examine each breast with the pads of his or her three middle fingers They will start under your collar bone (clavicle) and work across your breast back and forth in "grids", moving down the width of one finger. After the doctor finishes checking your breast, they may examine your nipple gently and look for discharge (fluid coming out of the nipple) or blood.

The doctor will include the area up into your armpit. You have lymph nodes in this area. Cancer can spread to lymph node tissue. One breast examination will take at least 3 minutes to complete.

What is the doctor checking for?

The main thing to look for is any change in your breasts. It's normal for your breasts to be different sizes. A firm ridge in the lower curve of your breast is also normal.

Changes to look for in your breasts

	Any new lump, which may not be painful or tender
	Unusual thickening of your breasts
	Sticky or bloody discharge from your nipples
	Any changes in the skin of your nipples or breasts, such as puckering or dimpling
	An unusual increase in the size of one breast
	One breast unusually lower than the other

Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.