CLINIC EXAM OF THE BREAST.

It must be performed by the physician or medical nurse (where there isn’t a physician), yearly for women over 40 years. Between 20- 30 years of age the exam should be performed by a physician to every three years.

It consist of inspection of the breasts and surrounding areas regarding the shape, size, colour and any abnormal change. Then it must be done the palpation of the breast and the axillary and supraclavicular lymphatic nodes.

SELF-EXAMINATION OF THE BREASTS

To be inured with the normal aspect and consistence of the breasts, self-examination must be done monthly. It is important that examination to be performed in the same day of each month.

If the woman is during the menstrual cycle, the examination must be performed in the last day of the cycle, when the breasts are less sensitive and tumefiated. In case of a pregnancy or a postmenopausal state, it is necessary to choose a day of the month, for example the first day, when self-examination will be done monthly.

The first three steps are focussed on visible changes in shape and contour of the breasts:

  • Step 1: The inspection of the breasts is done in front of a mirror with arms along the body. It must be insisted on unusual aspects like a prominent area, retraction of skin, scars, increased size of breasts, any change of a mole.It is checked for existence of a discharge of the nipple, some changes in the nipple’s position and aspect.
  • Step 2: With the arms above the head, the breasts are examined in the mirror seeking the same objectives like in former step.
  • Step 3: With the hands on yours hips, push strongly and observe yours breasts. Then incline the body toward the mirror, with the shoulders and elbows pushed forward, verifying in the same time the occurrence of skin’s prominence or retraction.The next steps stress the changes of breast’s consistence:
  • Step 4: With the arms up and left hand on the neck, the breast is examined with the right hand. With stretched fingers, starting from the exterior border, you press firmly in small circles, in the same time moving the hand around the breast in smaller circles till you rich the nipple. It must be insisted on the area between the breast and the axilla and on axillary zone, too. It is critical to examine every part of the breast. Then, you have to repeat the procedure for the right breast.
  • Step 5: Lying down, with the left arm under the head and a pillow under the left shoulder, the left breast is examined with the right hand using the same circular moving described before. The same proceeding is done for the right breast using the left hand.

RECOMMENDATIONS FOR SCREENING

The American Cancer Society recommends the followings for detection of breast cancer at asymptomatic women:

For the age of 20-39 years old: monthly self-examination of breasts, a clinic exam to every 3 years, for the age of 40 years old: monthly self-examination of breasts, yearly clinic exam and mammography. Historically, the scientific data, which support the breast cancer’s screening, were more strongly for women of 50 years old than those of 40.

Screening through regular mammograms decreased the mortality of breast cancer with 30% for women of 50 years or older. However, the interpretation of results for women between 40 and 49 years old was a controversial subject. Once with the prolonging of follow-up period, the findings of a benefit for women of 40s came closer to those for women over 50 years.

In USA the National Cancer Institute makes the following recommendations:

  • Women of 40 years or older need to have a screening mammography to every 2 years.
  • Women with a high risk of breast cancer should ask the specialist’s advice regarding the need of a screening mammography before 40 years and the frequency of the screening.
  • In Romania, the Oncology Institute Bucharest recommends the followings through the detection centres:
  • For women of 40-45 years old monthly self-examination of the breasts, yearly clinic exam of the breasts and a mammography to every 3 years.
  • For women of 45-50 years old monthly self-examination of the breasts, medical control performed by physician every year and a screening mammography to every 2 years.
  • For women over 50s monthly self-examination, yearly clinic exam performed by physician and yearly mammography.

THE PREVELANCE OF THE MAMMOGRAPHY

In Romania, this wasn’t estimated. In USA, in accordance with data of 1994, belonging to National Study of Health’s Survey, 56% women of 50 years old and over and 45% women of 70 years (or older) reported that they had a mammography with 1-2 years ago. Women from group with age of 50 years with a lower educational status had the lower probability to have a mammography recently, the proportion of it’s realisation being 38-42%.

For Romania, the efforts to intensify the screening must be oriented toward older women with risk for breast cancer, women at retirement and women from lower socioeconomic status.