A) Self examination: the woman is asked to regularly examine her own breasts to look for any new changes within them. She is specifically asked to watch out for new lumps or masses in her breasts. She has also to look for changes in the pre-existing lumpiness in her breasts. Any painful areas or those lumps within the breast that increase in size or hardness must be especially palpated during self-examination.
B) Clinical examination by a doctor: the woman must consult a doctor or medical professional, if she feels uncomfortable with the changes taking place in her breasts. Gradually, the changes of fibrocystic breasts might increase or decrease. In any case, the changes must be reported to the doctor who will examine her breasts by palpation. The doctor looks specifically for those changes that suggest severe fibrocystic changes or more ominously, changes of cancer. The clinician specifically looks for pain and tenderness (pain on touch) in the nodules. In addition, he looks for lack of mobility of the nodule or lump as this indicates possible cancerous change. Cancerous lumps tend to stick to the underlying muscles or overlying skin due to their tendency to invade nearby tissues. Severe fibrocystic breast patients and those suspected of harboring cancerous lumps are sent for further tests. These include – imaging tests and histo-pathological tests.
C) Imaging tests: Breast imaging uses primarily a) Mammography and b) Ultrasound imaging of the breasts to rule out cancer and study the breast tissue in detail.
1. Mammography. Mammography is a special X-ray imaging technique to look for solid lesions (lumps) that might suggest cancer in the tissue. Those lumps that are due to cancer have specks of calcium (called micro-calcification) and have irregular margins around them. In addition, they tend to adhere to surrounding fat or skin and muscle. Both ultrasound and breast mammography are non-invasive tests (no introduction of needles or need for incision of the body) that require little time and are relatively inexpensive. There is however, a small risk of x-ray radiation in the use of mammography. Mammography is now considered essential and indicated in all women more than 30 yrs. of age.
2. Ultrasound. Here a high resolution probe is used to examine the breasts to look for unusual lumps or tumors, especially those that can be potentially cancerous. Ultrasound is the best imaging modality that is available today, that is cost effective, non-invasive and absolutely safe (there are no known side effects of ultrasound tests). In addition to cancer in the breasts, ultrasound helps study the nature of the cysts and solid lumps within the tissue and also helps to monitor the change in size of these lesions. With its ability to visualize the internal structure of the both solids and cystic structures, ultrasound can detect cancer in its very early stages. In addition, CT and MR imaging also have a role to play in certain cases where ultrasound alone is insufficient.
3. Thermography. Medical thermography, or Digital Infared Imaging (DIDI) uses infrared imaging technology to take highly detailed and sensitive images of the human body. Approved by the FDA in 1982 as a breast cancer risk assessment tool, there have been over 800 research papers given on thermography and over 300,000 women have been imaged using this technique. Their main clinical use has been as a breast screening test to look for early signs of fibrocystic disease or cancer.
Conventional medical doctors prefer mammography to thermography as a screening test, but some use thermograms to follow malignancies once they have developed. Patients often prefer thermograms to mammograms because there is no compression of the breast or radiation exposure in these heat-sensitive tests. Thus they are safer than mammograms and more comfortable. Both tests have their advantages, so some women choose to rotate the tests in alternate years to receive the benefit of both.
Biopsy of the breast lumps is indicated when imaging and clinical examination show a potentially suspicious lump in the breast.