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Breast Self Exam

What to Look For When Checking Your Breasts

Brought to you by: California Pacific Medical Center

The breast consists of glandular, connective, and fatty tissue that supports the production and delivery of milk. Breast changes occur both in relation to a womans menstrual cycle and to her levels of the hormones estrogen and progesterone. Often, a woman may notice that her breasts have developed dense areas and feel lumpy before she starts her period. Nearly half of all women may experience this lumpiness, which is usually the result of changes to the fibrous tissue within the breast. Although they may cause temporary pain, they are harmless and require no treatment. A single lump, on the other hand, warrants further investigation, especially if it remains unchanged through one or two menstrual cycles. A breast lumpthe kind that can be found through self-examination or a clinical exam performed by your doctorwill stand out from the surrounding tissue and may vary in size, shape, location, and firmness. Although the majority of breast lumps turn out to be benign, you should always contact your primary care provider or gynecologist if you notice anything abnormal. After conducting a physical exam and obtaining a health history, your doctor may recommend that you have a mammogram, ultrasound, or both. We encourage women to know their bodies and know their breasts. If something feels different in your breast, you should contact your health care provider. We want to know to about it, says breast surgeon Peter Richards, M.D.

The Asymptomatic Lump

Approximately 25 percent of breast lumps are found through a self-exam or clinical exam. The majority, however, are detected through routine mammograms. A mammogram can detect calcifications and masseselements that are not necessarily cancerous but warrant a closer look through an additional mammogram, ultrasound, and possibly biopsy. Breast ultrasound helps determine whether the lump is a noncancerous, fluid-filled cyst or a solid mass. A cyst may be left alone, or, if it is painful, it may be treated by draining the fluid through a thin, hollow needle. If the mass is not a cyst, the next

step is a biopsy to determine if cancerous cells are present. A noncancerous tumor will likely also be left alone but closely monitored for growth.

When It Is Cancer

Polly Marshall was among those whose annual mammogram showed something suspicious. Marshall, 52 at the time, returned for additional imaging and a biopsy, and within days she learned she had cancer. Each womans situation is unique and her breast cancer treatment may involve one or more modalities, including surgery, radiation, and chemotherapy. Several factors, including tumor size and location, and the spread of the disease, help determine the most appropriate surgical treatment. Options range from a lumpectomy, which removes the tumor while leaving the breast largely intact, to a mastectomy, which removes the whole breast. And in some cases lymph nodes are also removed. We are now performing a lot more oncoplastic procedures, as well as skin-and nipple-sparing mastectomies that allow us to restore a natural-looking breast, says breast surgeon Amara Malik, M.D. We are fortunate to have a team here that is experienced in techniques that allow a better cosmetic outcome for our patients. Polly, whose cancer was caught early, is now 18 months out of treatment and very active in a breast cancer support group offered at Sutter Healths CPMC. She advises women who receive a positive mammogram not to panic prematurely and has these wise words for the newly diagnosed: So much has progressed in terms of treatment, and there are so many good people working on this disease. Take your time to find whats right for you. You can beat this. Early detection offers the best defense. Heres what you need to know about breast lumps: Call your health care provider if you notice:
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A lump in or near your breast or under your arm Thick or firm tissue in or near your breast or under your arm A change in the size or shape of your breast Changes in or discharge from your nipples Changes to the skin, including redness, dimpling, or scaling