Breast cancer is the most common cancer among women, other than skin cancer. And according to the American Cancer Society, it is the second leading cause of cancer death in women; the chance of a woman having invasive breast cancer sometime during her life is about 1 in 8.

But the good news is that cancer death rates are going down. Improved treatment capabilities and earlier detection are credited for helping women catch it early.

Your risk

"Every woman is at risk, and the risk increases as you age," explains Deborah Kerlin, MD, director of breast health services for John Muir Health. "It is important for each woman to be familiar with the physical characteristics of her own breasts so that she is aware of changes that may occur over time."

Fortunately, most changes are normal and benign. If there is a problem, early identification allows for rapid evaluation and increases the potential for successful treatment.

Early detection

"Most suspected risk factors are not fully understood and therefore can't be controlled," says Carolyn Berson RN, MSN, nurse educator/patient navigator at John Muir Health. "But you can take steps for early detection and appropriate treatment."

Proactive measures include:

  • Performing breast self-exams (BSE) beginning at age 20.
  • Having a clinical breast exam (CBE) every three years by a health professional if you are 20-39 years old. Then annually after age 40.
  • Annual mammograms for women over 40.

What to look for

Women should know how their breasts normally look and feel. Beginning at age 20, you may want to examine your breasts once in a while.

The best time to do a breast self-exam is 7 to 10 days after the start of your menstrual period, when swelling and tenderness are minimal. If you no longer have periods, are pregnant, or are currently breastfeeding, choose a regular time for BSE. Look for:

  • Lump or mass in breast or armpit
  • Change in size or shape of breast
  • Dimpling or redness of the skin
  • Itching, scales, sores, or rashes
  • Sudden nipple inversion
  • Abnormal nipple discharge or bleeding

See your doctor if you have any of these symptoms. And remember, 8 out of 10 breast lumps are not cancerous.


Your doctor will first carefully feel the lump and surrounding tissue. Then the doctor may use mammography, and in some cases an ultrasound test, to help identify the breast mass. A needle aspiration or needle biopsy of the mass may yield fluid or indicate a solid mass, giving additional information.

Techniques such as stereotactic breast biopsy, where delicate instruments are guided to a specific area by the use of three-dimensional scanning, and core biopsy guided by ultrasound, make the procedures more reliable, cost-effective, and less invasive than surgical biopsy.


Mammograms are quick and easy. As you stand facing the X-ray equipment, the technologist places your breast between two plastic plates, compressing it briefly.

The process is designed to get a clear picture of your breast. The entire procedure only takes 5 to 10 minutes and may detect lumps that are still too small to feel.

"Screening mammography is the best tool available to screen for breast cancer," observes Vivian Wing, MD, chair of the department of medical imaging at John Muir Health. "Multiple, randomized, controlled trials and observational trials have clearly shown a decrease in breast cancer mortality with screening," she says

Those without insurance and low-income and underinsured women can call 1-800-4-CANCER for details about free annual mammography screenings.

Be proactive

Health care providers agree that no one method of detection is 100 percent accurate. But what is important is that if you do have a suspicious lump, you catch it early.

A three-pronged approach of BSE, CBE, and mammography is your best chance at early detection.

"Learning and practicing BSE, staying on a regular schedule of clinical breast exams and following the appropriate guidelines for mammograms are all highly effective screening tools," notes Dr. Kerlin. "Early diagnosis and treatment are key."

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