Breast self-examination (BSE) has also become very controversial. Recent publications from the American Cancer Society and other prestigious organization suggest that BSE does not work, and may lead to excess numbers of biopsies, as well as needless anxiety. As an alternative to formal BSE, these organizations recommend that a woman become aware of her breast, and to report any changes her physician. As a result of these ambiguous recommendations, women are understandably confused about what to do. All too often this leads to doing nothing. As a result, we are seeing more advanced cancers in women who (for various reasons) do not do breast self-examination.

Our experience convinces us that women can find breast cancers at a very early stage in their development. In many cases, these are potentially curable cancers that don’t show up on the mammogram or are discovered between routine yearly mammograms. The challenge is for the physician to teach proper self-examination. This is best done at the time of the physical examination, and should be repeated by the patient for several nights in a row until she has a clear mental image of her baseline (normal) breast pattern. Following this, BSE should be done monthly. Any change(s) should be reported to her physician. If the physician does not take appropriate action, a second opinion should be obtained.

We believe women should start doing monthly BSE as soon as she develops breasts, and should continue to do it with confidence throughout her life. Menstruating women should do it 7-10 days after their periods (when the breasts are the least engorged and tender). After menopause, it should be done once a month (we usually suggest the first day of every month). Peri-menopausal women should also do monthly examinations, but if they feel as though they are premenstrual (with tender, engorged breasts) at the time of scheduled self-examination, the examination should be post-poned a week or two (Link to: Breast Self Examination Classes and see video )

High-risk women include women with a strong family history of breast or ovarian cancer, previous high risk biopsies (such as those with atypia), and women with a previous history of breast cancer.

In these women, special counseling and individualized plans of action are indicated. If possible, these women should be followed in a center that specializes in caring for women at high risk of developing a future breast cancer.

• Breast Utra-Sound :

The concept of screening women with yearly ultrasound is gaining some momentum, but this procedure is not a standard of care, and hence is not covered by most insurances. One of the major problems of mammographic screening is that the mammogram can miss a cancer. This is especially true in the case of dense breast tissue, which is most commonly found in younger women. We are particularly concerned about young, high-risk women with dense breasts. It would be valuable for us to have an inexpensive screening device for this subset of women.

Several test models for have been developed for ultrasound screening, and we are impressed with the progress to date. The major problem has been a high level of “false positives”. In other words, changes are seen on the ultrasound which are concern, but on biopsy, most turn out to be benign. Until some of these basic problems are resolved, ultrasound will not be available for general/standard use in the community.





• Breast MRI :
  

The MRI is an excellent tool for the early detection of breast cancer. When an MRI is negative, the chances are about 98% that there is no cancer in the breasts (compared to a negative mammogram, which reflects about an 80% chance of having no cancer in the breasts). The problem with MRI is the high rate of finding areas of concern which, when biopsied, prove to be benign (a high false positive rate). The second problem is cost. An MRI costs thousands of dollars and is only reimbursed by insurance companies in selected high-risk cases, such as a woman with a very strong family history, previous history of breast cancer or high-risk biopsy, or suspected implant rupture ( Also link to : What's New - MRI )

Women who have MRIs should also have a yearly mammogram since some changes (such as microsopic calcifications) are best detected on the mammogram.

• Nipple Cytology :

  One of the challenges facing physicians who specialize in breast care is to identify women at an increased risk for breast cancer, yet who don’t have a strong family history and have not had a previous high-risk biopsy. The advantage of a screening device that would separate women at high risk from women at normal risk would be first, to reassure women at normal risk, and second, to identify women at high risk so that they can be followed more aggressively.
  
  A new device has been introduced that attempts to solve this problem. The device is called the Halo-Pap test. A small suction device is placed on the nipple in an attempt to extract fluid. If fluid can be removed, it is tested under the microscope. The finding of atypical cells suggests an increased risk of developing cancer in the future, and thus more aggressive follow-up is indicated (see link to: High-Risk Biopsies)
  
  In approximately 60% of the cases, no fluid is obtained, and it assumed that the finding of no fluids extracted indicates a low-risk situation and the woman can be reassured. In the majority of cases in which fluid is found, the cells are considered normal, and again only routine follow-up is indicated. In the case of an abnormal result, the patient is advised to see a breast care specialist.
  
  The test is new, and the long-term value has not been clearly established. However, the test is relatively inexpensive (approximately $100.00), but it is not covered by most insurances. We believe that this will be a valuable test for women who feel strongly about obtaining more information about their personal risk for developing breast cancer.