Breast cancer is the second most common cancer among women, ranking as the second leading cause of death from cancer. Although it can occur in both men and women, it's far more common in women. It is estimated that about 1 in 8 Canadian women will develop breast cancer during their lifetime and 1 in 33 will die from it. Surprisingly only 5 to 10% of breast cancers occur in women with a clearly defined genetic predisposition for the disease, but the majority of breast cancer cases are "sporadic,” meaning there is no definitive gene mutation. All women are at some risk for developing breast cancer, but increasing age is the most common risk factor, with 66% being diagnosed after the age of 55. Other risk factors may include: Obesity, Alcohol, exposure to radiation, early menarche, late menopause, personal history of breast cancer, family history of breast cancer, Inherited genes that increase cancer risk (as BRCA1 and BRCA2), and postmenopausal hormone therapy. In the past two decades breast cancer survival rates have increased. Breast cancer mortality rates among Canadian women have declined from 41.7 per 100 000 in 1988 to an estimated 23.2 per 100 000 in 2017, while age-standardized incidence has remained relatively stable, at around 130 per 100 000 since 2004. Declining mortality with stable incidence could reflect the improvements in breast cancer treatment, timely detection of symptomatic cancer, screening programs, or all of these. Breast cancer screening programs have been in place in most regions of Canada since the early 1990s. Women are encouraged to be enrolled into these programs, which can help maintain breast health and detect cancer early, when it is easier to treat and more likely to be cured. Although the Canadian Task Force on Preventive Health Care does not recommend breast self-examinations for women ages 40 to 74 who do not have a higher risk of breast cancer as there is little evidence that these tests help find breast cancer early in women getting screening mammograms, But women should be familiar with how their breasts normally look and feel and should report any changes to a health care provider right away. Self-exams are important for breast health, but they should not replace screening programs and tests. It usually takes only a few minutes and can be easily incorporated into a regular routine, such as before sleeping or during a shower. The best time for breasts examination is usually 1 week after the menstrual period starts, when breasts are least likely to be swollen or tender, and in order to be able to compare results of one examination with another. If menstruation is irregular or has stopped due to menopause or hysterectomy, it is recommended to do the examination on a fixed day every month. To do a breast self-examination:
Start by Visual inspection of both breasts, Remove all clothes above the waist, and stand in front of a mirror. look for any changes in breast shape or size, breast swelling, skin dimpling or changes in the nipples, with your arms down by your sides, then raise high overhead, and finally hands on your hips and press firmly to make chest muscles flex.
Then examine your breasts while lying down (as it helps to spread breast tissue evenly over the chest and makes it easier to feel lumps or changes) using the pads of the three middle fingers, check the entire breast from the collarbone to the bottom of the bra line and from the armpit to the breastbone. Use three different levels of pressure to feel all of the breast tissue; Light pressure is needed to feel the tissue close to the skin surface, medium pressure is used to feel a little deeper, and firm pressure is used to feel tissue close to the breastbone and ribs.When in doubt about a particular lump, check the other breast. If you find the same kind of lump in the same area on the other breast, then both breasts are probably normal. Warning signs of breast cancer can include:
A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
Change in the size, shape, or contour of the breast.
Blood-stained or clear fluid discharge from the nipple.
Change in the look or feel of the skin on the breast or nipple (dimpled, puckered, scaly, redness, or inflamed).If any of these changes were found by routine self examination, it is important to stay calm as most self-exam findings are not signs of breast cancer, but you should still notify your health care provider. On the other hand, breast screening with a mammogram is the best way for early diagnosis of breast cancer. Mammograms are low-dose x-rays of the breast. Regular screening programs can help find breast cancer at an early stage, when treatment is most successful. It can often find breast changes that could be cancer years before physical symptoms develop. Regular mammography is the best way for women who are at average risk to be proactive about their breast health. For screening purposes, a woman is considered to be at average risk if she doesn’t have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer (such as in a BRCA gene), and has not had chest radiation therapy before the age of 30. Guidelines recommend that women between 40 and 49 have the option to start screening with a mammogram every year according to patient values and preferences. For women aged 50 to 74 years, it is recommended to be enrolled in regular screening with mammography every two to three years. It is important for women to understand what to expect when getting a mammogram for breast cancer screening. Mammograms are not perfect. They may miss some cancers, and sometimes a woman may need more tests to confirm or rule out a suspicious finding on a mammogram. In recent years, a newer type of mammogram called digital breast tomosynthesis (commonly known as three-dimensional <3d> mammography) has become much more common, several studies have shown it can be helpful in women with more dense breasts. Although it’s not available in all breast imaging centers. It should be noted that 3D mammograms often cost more than regular 2D mammograms, and this added cost may not be covered by insurance.