According to the American Cancer Society, one woman out of eight will develop breast cancer sometime during her life. (Breast cancer is rare in men, accounting for less than 1 percent of all breast cancer.) Recent media attention has increased awareness and education about breast cancer, but still approximately 40,600 women will die from this disease in the next year. Although early detection and corresponding treatment results in higher cure rates, breast cancer remains the leading cause of cancer death of adult women less than 54 years of age and the second most common cause after age 54.

What is breast cancer?

Breast cancer is associated in many women's minds with the discovery of a lump in the breast. But not all lumps in the breast are tumors. Some lumps are masses of connective or scar tissue called fibrosis or fluid-filled sacs called cysts. Even when breast lumps are tumors, not all tumors are equally serious. Most are noncancerous or benign tumors-abnormal growths that do not spread outside of the breast and are not life threatening. The most serious are malignant tumors. Malignant tumors are masses of cancer cells that can invade surrounding tissues or spread (metastasize) to other areas of the body. Some noncancerous tumors have the potential to become malignant at some stage. These are called premalignant or precancerous tumors.

Who is at increased risk of breast cancer?

Exact causes of breast cancer are not known, but research has shown that certain risk factors are linked to the disease. A risk factor is anything that increases a person's chance of getting a disease, such as cancer. While all women are at risk for breast cancer, there are some factors that can increase a woman's chances of getting breast cancer. You cannot change risk factors such as gender, age, race, or family or personal history of breast cancer. However, you can reduce or eliminate other risk factors. Avoiding excessive use of alcohol, maintaining a healthy weight, limiting intake of high-fat foods, and following a moderate exercise program all have been shown to help prevent breast cancer.

What is a "breast self-exam?"

A breast self-examination is easy to do, and an important part of early detection. Many breast lumps are found by women performing self-exams. By doing frequent (monthly) self-exams, you learn how your breast normally feels and become better able to detect any changes.

The best time to examine your breasts is after your menstrual period when they are not tender or swollen. If you do not have regular periods, or are past menopause, examine your breasts on the same day of every month.

The American Cancer Society suggests the following steps to follow for breast self-examination:

• Lie down and put a pillow under your right shoulder. Place your right arm behind your head.
• Use the finger pads of the three middle fingers on your left hand to feel for lumps or thickening in your right breast. (Your finger pads are the top third of each finger.)
• Press firmly enough to know how your breast feels. If you are not sure how hard to press, ask your health care provider to teach you. Or try to copy the way your health care provider uses the finger pads during a breast exam. Learn what your breast feels like. A firm ridge in the lower curve of each breast is normal.
• Move your fingers around the breast in a set way and do it the same way each month. This will help assure that you have gone over the entire breast area, and to remember how your breast normally feels.
• Move the fingers around the outside of your breast in a circular motion, then do the same around the nipple.
• Move the fingers in an up and down motion starting from the bottom of your breast and going to the top of your breast, then back down to the bottom of your breast again.
• Use a "wedge" motion, moving your fingers from the outside of your breast toward your nipple, and continue clockwise around your breast.
• Next, examine your left breast using the right-hand finger pads.
• Finally, repeat the examination of both breasts while standing, with one arm behind your head. The upright position makes it easier to check the upper and outer parts of the breasts (toward your armpit). You may want to do the standing part of the exam while you are in the shower. Some breast changes can be felt more easily when your skin is wet and soapy.

You also should check your breasts for any dimpling of the skin, changes in the nipple, redness, or swelling while standing in front of a mirror right after your self-exam each month.

If you are having difficulty with the self-exam or would like to be sure you are doing it correctly, health professionals at your doctor's office or at the local health department can help you. And if you find a lump or notice any of the conditions stated above, be sure to contact your health care provider immediately.

What is a mammogram?

A mammogram is another way to examine your breasts for lumps or tumors. A mammogram involves x-ray pictures of your breast and takes about 20 to 30 minutes. This helps your doctor see any abnormal breast tissue and, if a tumor exists in the breast, identify the size and location of the tumor.

When should breast self-exams and mammograms be done?

The American Cancer Society recommends the following:

• Breast self-exams are encouraged beginning at age 20.
• Clinical breast exams (those done in the doctor's office) should be done every one to three years from age 20 to 39.
• Annual mammograms and clinical breast exams should be done beginning at age 40.
  
• Clinical breast exams should be done at the time of regularly scheduled mammograms.

It is important to remember that these are simply guidelines, and that women with an increased likelihood of getting breast cancer based on the above risk factors may need to begin screening earlier and may need to seek screening more frequently.

INTERNET RESOURCES

Patient Breast Center A resource from The National Cancer Institute with information on treatment, quality of life, detection, screening, prevention, risk factors and genetics. wwwicic.nci.nih.gov

National Breast Cancer Coalition This site provides updates on breast cancer events and activities, current information about breast cancer, and has a national list of support groups and other Internet sites. www.natlbcc.org

Oncolink: Psychological Support and Personal Experiences This University of Pennsylvania site provides links to many other cancer sites, including those with support for cancer patients and their families. www.oncolink.com

RESOURCES

American Cancer Society, 599 Clifton Road, NE, Atlanta, GA 3032, 800-ACS-2345, www.cancer.org