Click Here for information on Nursing Programs!

Learn about HERBS!



Breast Exams
Causes of Breast Cancer
Early Detection of Breast Cancer
Mammogram Information
Paying for Breast Exam Screening
Signs and Symptoms of Breast Cancer
Recommendations for People Who Do Not Have Breast Cancer

Breast Exams for Breast Cancer


Clinical breast exam

A clinical breast exam (CBE) is an examination of your breasts by a health professional, such as a doctor, nurse practitioner, nurse, or physician assistant. For this exam, you 

undress from the waist up. The health professional will first look at your breasts for abnormalities in size or shape, or changes in the skin of the breasts or nipple. Then, using the pads of the fingers, the examiner will gently feel (palpate) your breasts.

Special attention will be given to the shape and texture of the breasts, location of any lumps, and whether such lumps are attached to the skin or to deeper tissues. The area under both arms will also be examined.

The CBE is a good time for women who don't know how to examine their breasts to learn the right way to do it from their health care professionals. Ask your doctor or nurse to teach you and watch your technique.

Breast awareness and self-exam

Beginning in their 20s, women should be told about the benefits and limitations of breast self-exam (BSE). Women should be aware of how their breasts normally look and feel and report any new breast changes to a health professional as soon as they are found. Finding a breast change does not necessarily mean there is a cancer.

A woman can notice changes by knowing how her breasts normally look and feel and feeling her breasts for changes (breast awareness), or by choosing to use a step-by-step approach and using a specific schedule to examine her breasts.

Women with breast implants can do BSE. It may be useful to have the surgeon help identify the edges of the implant so that you know what you are feeling. There is some thought that the implants push out the breast tissue and may make it easier to examine. Women who are pregnant or breast-feeding can also choose to examine their breasts regularly.

If you choose to do BSE, the following information provides a step-by-step approach for the exam. The best time for a woman to examine her breasts is when the breasts are not tender or swollen. Women who examine their breasts should have their technique reviewed during their periodic health exams by their health care professional.

It is acceptable for women to choose not to do BSE or to do BSE occasionally. Women who choose not to do BSE should still know how their breasts normally look and feel and report any changes to their doctor right away.

How to examine your breasts

Lie down on your back and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.

Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.

Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but, you should tell your doctor if you feel anything else out of the ordinary. If you're not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.

self exam    hand

Breast Self Examination

Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).

There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast without missing any breast tissue.

Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.

While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)

Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

This procedure for doing breast self-exam is different from previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman's ability to find abnormal areas.

Newer technologies for breast cancer screening

Mammography is the current standard test for breast cancer screening. MRI is also recommended along with mammograms for some women at high risk for breast cancer. Other tests, such as ultrasound, are now being studied as well.

Magnetic resonance imaging

For certain women at high risk for breast cancer, screening magnetic resonance imaging (MRI) is recommended along with a yearly mammogram. MRI is not generally recommended as a screening tool by itself, because although it is a sensitive test, it may still miss some cancers that mammograms would detect. MRI may also be used in other situations, such as to better examine suspicious areas found by a mammogram. MRI can also be used in women who have already been diagnosed with breast cancer to better determine the actual size of the cancer and to look for any other cancers in the breast.

MRI scans use magnets and radio waves, instead of x-rays, to produce very detailed, cross-sectional images of the body. The most useful MRI exams for breast imaging use a contrast material (gadolinium) that is injected into a small vein in the arm before or during the exam. This improves the ability of the MRI to clearly show breast tissue details.

MRI scans can take a long time -- often up to an hour. You have to lie inside a narrow tube, which is confining and may upset people with claustrophobia (a fear of enclosed spaces). The machine makes loud buzzing and clicking noises that you may find disturbing. Some places provide headphones with music to block this noise out.

Although MRI is more sensitive in detecting cancers than mammograms, it also has a higher false-positive rate (when the test finds something that turns out not to be cancer), which results in more recalls and biopsies. This is why it is not recommended as a screening test for women at average risk of breast cancer, as it would result in unneeded biopsies and other tests in a large portion of these women.

Just as mammography uses x-ray machines that are specially designed to image the breasts, breast MRI also requires special equipment. Breast MRI machines produce higher quality images than MRI machines designed for head, chest, or abdominal MRI scanning. However, many hospitals and imaging centers do not have dedicated breast MRI equipment available. It is important that screening MRIs are done at facilities that can perform an MRI-guided breast biopsy. Otherwise, the entire scan will need to be repeated at another facility when the biopsy is done.

MRI is more expensive than mammography. Most major insurance companies will likely pay for these screening tests if a woman can be shown to be at high risk, but it's not yet clear if all companies will. At this time there are concerns about costs of and limited access to high-quality MRI breast screening services for women at high risk of breast cancer.

Breast ultrasound

Ultrasound, also known as sonography, is an imaging method in which sound waves are used to look inside a part of the body. For this test, a small, microphone-like instrument called a transducer is placed on the skin (which is often first lubricated with ultrasound gel). It emits sound waves and picks up the echoes as they bounce off body tissues. The echoes are converted by a computer into a black and white image that is displayed on a computer screen. This test is painless and does not expose you to radiation.

Breast ultrasound is sometimes used to evaluate breast problems that are found during a screening or diagnostic mammogram or on physical exam. Breast ultrasound is not routinely used for screening. Some studies have suggested that ultrasound may be a helpful addition to mammography when screening women with dense breast tissue (which is hard to evaluate with a mammogram), but the use of ultrasound instead of mammograms for breast cancer screening is not recommended.

Ultrasound is useful for evaluating some breast masses and is the only way to tell if a suspicious area is a cyst (fluid-filled sac) without placing a needle into it to aspirate (pull out) fluid. Cysts cannot be accurately diagnosed by physical exam alone. Breast ultrasound may also be used to help doctors guide a biopsy needle into some breast lesions.

Ultrasound has become a valuable tool to use along with mammograms because it is widely available, non-invasive, and less expensive than other options. However, the effectiveness of an ultrasound test depends on the operator's level of skill and experience. Although ultrasound is less sensitive than MRI (that is, it detects fewer tumors), it has the advantage of being more available and less expensive.


This test, also called a galactogram, is sometimes helpful in determining the cause of nipple discharge. Most nipple discharges or secretions are not cancer. In general, if the secretion appears milky or clear green, cancer is very unlikely. If the discharge is red or red-brown, suggesting that it contains blood, it might possibly be caused by cancer, although an injury, infection, or benign tumors are more likely causes.

In this test a very thin plastic tube is placed into the opening of the duct at the nipple. A small amount of contrast material is injected that outlines the shape of the duct on an x-ray image and shows if there is a mass inside the duct.

Digital mammograms

A digital mammogram (also known as a full-field digital mammogram or FFDM) is like a standard mammogram in that x-rays are used to produce an image of your breast. The differences are in the way the image is recorded, viewed by the doctor, and stored. Standard mammograms are recorded on large sheets of photographic film. Digital mammograms are recorded and stored on a computer. After the exam, the doctor can view them on a computer screen and adjust the image size, brightness, or contrast to see certain areas more clearly. Digital images can also be sent electronically to another site for a remote consult with breast specialists. While many centers do not offer the digital option at this time, it is expected to become more widely available in the future.

Because digital mammograms cost more than standard mammograms, studies are now under way to determine which form of mammogram will benefit more women in the long run. Some studies have found that women who have FFDM have to return less often for additional imaging tests because of inconclusive areas on the original mammogram. A recent large study found that FFDM was more accurate in finding cancers in women younger than 50 and in women with dense breast tissue, although the rates of inconclusive results were similar between FFDM and film mammograms. It is important to remember that a standard film mammogram also is effective for these groups of women, and that they should not miss their regular mammogram if digital mammography is not available.

Computer-aided detection and diagnosis

Over the past 2 decades, computer-aided detection and diagnosis (CAD) has been developed to help radiologists detect suspicious changes on mammograms. This can be done with standard film mammograms or with digital mammograms.

Computers can help doctors identify abnormal areas on a mammogram by acting as a second set of "eyes." For standard mammograms, the film is fed into a machine, which converts the image into a digital signal that is then analyzed by the computer. Alternatively, the technology can be applied to a digital mammogram. The computer then displays the image on a video screen, with markers pointing to areas it "thinks" the radiologist should check especially closely.

It's not yet clear how useful CAD is. Some doctors find it helpful, but a recent large study found it did not significantly improve the accuracy of breast cancer detection. It did, however, increase the number of women who needed to have breast biopsies. Further research of this approach is needed.

Scintimammography (molecular breast imaging)

In scintimammography, a slightly radioactive tracer called technetium sestamibi is injected into a vein. The tracer attaches to breast cancer cells and is detected by a special camera.

This is a newer technique that most doctors still consider be experimental. Some radiologists believe it is sometimes useful in looking at suspicious areas found by regular mammograms, but its exact role remains unclear. Current research is aimed at improving the technology and evaluating its use in specific situations such as in the dense breasts of younger women. Some early studies have suggested that it may be about as accurate as more expensive MRI scans.

Tomosynthesis (3D mammography)

This technology is basically an extension of a digital mammogram. For this test, a woman lies face down on a table with a hole for the breast to hang through, and a machine takes x-rays as it rotates around the breast. Tomosynthesis allows the breast to be seen as many thin slices, which can be combined into a 3-dimensional picture. It may allow doctors to detect smaller lesions or ones that would otherwise be hidden with standard mammograms. This technology is still considered experimental and is not yet commercially available.

Other tests

These tests may be done for the purposes of research, but they have not yet been found to be helpful in diagnosing breast cancer in most women.

Nipple discharge exam

If you are having nipple discharge, some of the fluid may be collected and looked at under a microscope to see if any cancer cells are in it. But even when no cancer cells are found in a nipple discharge, it is not possible to say for certain that a breast cancer is not there. If a patient has a suspicious mass, a biopsy of the mass is necessary, even if the nipple discharge does not contain cancer cells.

Ductal lavage and nipple aspiration

Ductal lavage is an experimental test developed for women who have no symptoms of breast cancer but are at very high risk for breast cancer. It is not a test to screen for or diagnose breast cancer, but it may help give a more accurate picture of a woman's risk of developing it.

For this test, gentle suction is used to help draw tiny amounts of fluid from the milk ducts up to the nipple surface, which helps locate the milk ducts' natural openings on the surface of the nipple. A tiny tube is then inserted into a duct opening. Saline (salt water) is slowly infused into the tube to gently rinse the duct and collect cells. The fluid is then withdrawn through the tube and sent to a lab, where the cells are viewed under a microscope.

Ductal lavage is much more useful as a test of cancer risk rather than as a screening test for cancer. It is not considered appropriate for women who aren't at high risk for breast cancer. It is not clear whether it will ever be a useful tool. The test has not been shown to detect cancer early. More studies are needed to better define the usefulness of this test.

Nipple aspiration also looks for abnormal cells from the ducts. The device for nipple aspiration uses small cups that are placed on the woman's breasts. The device warms the breasts, gently compresses them, and applies light suction to bring nipple fluid to the surface of the breast. The nipple fluid is then collected and sent to a lab for analysis. As with ductal lavage, the procedure may be useful as a test of cancer risk but is not appropriate as a screening test for cancer. The test has not been shown to detect cancer early.

Talk to your doctor

If you think you are at higher risk for developing breast cancer, talk to your doctor about what is known about these tests and their potential benefits, limitations, and harms. Then decide together what is best for you.

For more information on imaging tests for early detection and diagnosis of breast diseases, refer to the separate American Cancer Society document, Mammograms and Other Breast Imaging Procedures.


Source: American Cancer Society

Note: Some statements in this article may not be approved by the FDA. This article is for informational purposes only and should not be taken as professional medical advice.

Privacy Statement




Compleat Mother
Main Page



Subscriptions are $12 a year,
$20 for two years

Lifetime Subscription: $200

Bulk Subscriptions
(5 magazines each issue) $22 a year or
$35 for 2 years

visa53x34.gif (501 bytes)   mastercard.gif (767 bytes)

To order, please click to our
Subscription Page 

Greg Cryns
The Compleat Mother Magazine
5703 Hillcrest
Richmond, Illinois 60071
Phone: (815) 678-7531