woman’s breasts change throughout her life. Factors such as

Anatomy of the Female Breast

age, monthly menstrual cycle, pregnancy, breastfeeding, birth

control or other hormone pills, menopause, or a bruise or

blow to the breast can cause these changes. In addition, breasts

vary in size, shape, and texture. Because most breast lumps are

found by women themselves, you should learn how to examine

Rib

Pectoralisminormuscle

Pectoralismajormuscle

Pectoralis majormuscle

Art: Harriet Phillips

FatMilklobes

Milk ducts

Nipples

Areola

Green linesdepictlymphaticdrainage

A

Lymph nodes

step 1Here’s what you should do to check for changes in your breasts. Standbefore a mirror. Check each breast for anything different from theprevious exam, such as any discharge from the nipples, puckering,dimpling, or scaling of the skin. Each time you examine your breasts youwill become more familiar with how they appear and feel, making iteasier to notice any changes that may occur. Notice the normal size andshape of each breast (it is not unusual for one breast to be larger than theother) and the normal position of the nipple.

your breasts and do so regularly. As youdo this, you will develop more confidencein knowing how your breasts normallyfeel and you should be able to recognizeany changes. If you do find a change,don’t let fear keep you from seeing yourdoctor, as most breast lumps are benign.

When breast cancer is found and treatedearly, a woman has more treatmentchoices and a good chance of completerecovery, so early detection is very im-portant. Breast self-examination shouldbe one component of your breast healthprogram, which also includes mammog-. .

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Clasp your hands behind your head and press them forward. You shouldfeel your chest muscles tighten. Look in the mirror at the shape andcontour of your breasts. Take your time; again, look for any changes inthe size and shape of each breast and look for any swelling, dimpling,rash, discoloration, or other unusual changes in the skin. Slowly rotateyour body from side to side to better view the size and shape of yourbreasts.

raphy at an appropriate age and physicalexamination of your breasts by a trainedhealth professional.

Breasts are made up of ducts, lobes,lobules, fibrous tissue, and fat, withunderlying muscle and bone (ribs). There-fore, it is normal for the breasts to feel

step 2

lumpy or uneven. This can vary duringyour monthly cycle. Before your men-strual period begins, and sometimes duringyour period, you may experience sometenderness, pain, or lumps in your breastsbecause extra fluid collects in the tissue.This is normal.. .

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step 3

step 4Gently squeeze each nippleand look for a discharge.Begin at the outer edge ofthe areola drawing your fin-gers towards the nipple. Ifpresent, see your doctor. Infact, if you have a dischargeat any time you should checkit out with your doctor. Re-member, most nipple dis-charges are harmless.

Next, press your hands firmly on your hips and bend slightly toward yourmirror as you pull your shoulders and elbows forward. Once again, youshould feel your chest muscles tighten. Look for any change in the shapeor contour of your breasts as well as any change in the nipples.

The next step is best done in bath or shower with soapy fingers to glideeasily over the skin. Raise your left arm. Use the pads of the fingers ofyour right hand to check your left breast and the surrounding area—firmly, carefully, and thoroughly. Feel for any unusual or new lump ormass under the skin. A lump is unusual if it has not been felt during earlierbreast exams and it now stands out against the normal feel of your breast.

step 5

Repeat step 5 lying down. Lie flat on your back, with your left arm overyour head and a pillow or folded towel placed under your left shoulder.This position flattens the breast and makes it easier to examine. Check theleft breast and the area around it very carefully, using one of the patternsdescribed on the opposite page. Repeat the exam on the right breast.

If your breasts are large, you may need to hold the side of each onesteady with your other hand while you are performing the examination.

There are different patterns or tech-niques to palpate or feel the breasts. Oneis not necessarily better than others. Con-sistency is the important issue. By usingthe same technique a woman can moreeasily identify a change. Always cover the

entire breast and pay special attention tothe area between the breast and the un-derarm, including the underarm itself.Check the area above the breast, up to thecollarbone and all the way over to yourshoulder. This area contains breast tissue.

step 6

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Start with your left breast, then repeat the exam on your right breast.

Use the pads of your fingers not your fingertips.

Feel your breast in overlappingareas without lifting your fingersfrom the breast.

Feel the tissue by pressing your fingers in small, overlapping areas about the size of a dime.To make sure that you cover your entire breast, take your time and follow a consistent pattern:circles, lines, or wedges.

Circles — Beginning at theouter edge of your breast,move your fingers slowlyaround the entire breast in acircle. Move around the breastin smaller and smaller circles,gradually working toward thenipple. Don’t forget to checkthe underarm and upper chestareas, too. Before concludingthe exam, depress the nippleinto a natural ‘‘well.’’ It shouldfeel smooth.

Lines — Start in your under-arm area and move your fin-gers downward little by littleuntil they are below the breast.Then move your fingers slight-ly toward the middle and slow-ly back up. Go up and downuntil you cover the entirebreast area. Be sure to checkthe underarm area and theupper chest. Before conclud-ing the exam, depress the nip-ple into a natural ‘‘well.’’ Itshould feel smooth.

Wedges — Starting at theouter edge of your breast,move your fingers toward thenipple and back to the edge.Check your entire breast, cov-ering one small wedge-shaped section at a time.Again, be sure to check theunderarm area and the upperchest. Before concluding theexam, depress the nipple intoa natural ‘‘well.’’ It should feelsmooth.

If you menstruate, the best time to do BSE is2 or 3 days after your period ends, whenyour breasts are least likely to be tender orswollen. If you no longer menstruate, pick aday, such as the first day of the month, toremind yourself it is time to do BSE and

step 7If you feel something in one breast that appears unusual or different frombefore, check to see if it is present in your other breast. If the same structure isin the same place in both breasts, the chances are good that your breasts arenormal. If you find a lump a few days before or during your menstrual period,reexamine your breasts at the end of your period. Often a lump that is found atthis time may be due to the normal collection of fluid during your period. If thelump doesn’t disappear before your next period begins, see your doctor soon.

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. . . write it down. If you are just learning how

to examine your breasts, you may want todo BSE once a week for a few months to seehow your breasts change over time. Onceyou know what is normal for you, do BSEregularly as part of body awareness.

For answers to questions you may have about breast exams or breast cancer, call thefollowing toll-free telephone number for the Cancer Information office serving your area:1-800-4-CANCER.

Prepared by Alice F. Judkins, RN, MS, Advanced Practice Nurse, Breast Specialist, formerlyof The University of Texas M. D. Anderson Cancer Center, and S. Eva Singletary, MD, FACS,Professor of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, incooperation with the Oncology Publishing Group.

Extra copies of this booklet are available. Prices are shown below. Prepaid orders only.

Checks payable to CMP Healthcare Media.CMP Healthcare Mediac/o Jules LeoOncology Publishing Group11 West 19th Street, 3rd FloorNew York, NY 10011or call 212-600-3012

From the Publishers of the Journal ONCOLOGY

Editor-in-Chief Martin D. Abeloff, MD

MAY 2004V O L U M E 13 N U M B E R 5

Oncology News International

ONIONI

Exemestane Bests Tam inMetastatic Breast Cancer

PAGE 46 — Isodose distribution in the axial view at the level of the cochlea (bilateral dark

circular structures—arrows) for x-rays (top left), IMRT photons (bottom left), and protons

(bottom right) for a posterior fossa boost in a child with medulloblastoma. Reprinted from Int

J Radiation Oncology Biol Phys 58:727-734, 2004. ©©©©© 2004 with permission from Elsevier.

REPORTS FROM11 MAJORONCOLOGYMEETINGS2

Evidence Builds forAnticancer Effects ofPhysical Activity

5‘War on Cancer’ aMisplaced Metaphor,Says Dr. Martin Abeloff

57Wide Excision WithoutRadiation Therapy NotSufficient in Small DCIS82IP Gemcitabine Promising in

Advanced Pancreatic Cancer

ONI on the WebFor more information, visitwww.cancernetwork.com

Appears on pages 68, 69ONI

CONTINUED ON PAGE 18

Esophageal Ca: No Benefit From Preop Chemo-RT

First front-linehead-to-head trial in metastatic breast cancer

CONTINUED ON PAGE 34

FPO

HAMBURG, Germany—The

steroidal aromatase inactivator exemes-

tane (Aromasin) is safe and provides su-

perior progression-free survival, com-

pared with tamoxifen, in the treatment

of postmenopausal woman diagnosed

with hormone-responsive metastatic

breast cancer, according to the first head-

to-head front-line phase III trial com-

paring the two agents. Robert Paridaens,

MD, of the University Hospital Gasthuis-

berg, Leuven, Belgium, presented the

findings at the 4th European Breast Can-

cer Conference (abstract 241).The EORTC’s (European Organiza-

tion for Research and Treatment of Can-

cer) Specialized Breast Group initiated

the randomized, open-label, phase II-III

trial in 1996. The trial aimed to further

document the safety profile of exemestane

and to determine if exemestane-treated

patients had at least a 3-month increase

in progression-free survival over tam-

oxifen. “This trial was initiated as a phase

II study with the possibility of extending

to phase III if results were promising,”

Dr. Paridaens said.Patients with measurable disease were

enrolled in the trial if they had not re-

ceived hormone therapy for metastatic

breast cancer and had either a hormone-

receptor-positive cancer or an unknown

status with a long disease-free period.

Patients were randomized to exemestane

25 mg daily or tamoxifen 20 mg daily.The results of the initial phase II study,

which included 122 patients, showed a

promising overall response rate, clinical

benefits rate, and response duration fa-

voring exemestane. Furthermore, serious

NEW YORK—A retrospective

review of 10 years of data on patients

who underwent surgical resection for

esophageal cancer has shown no survival

advantage for patients who had a com-

plete pathologic response to neoadjuvant

chemoradiation followed by surgery vs

those who had surgery alone. In light of

this finding, the researchers suggest that

Nashville Veteran’s Administration Hos-

pital, at the Society of Surgical Oncol-

ogy 57th Annual Cancer Symposium

(abstract 17).The investigators undertook this

study, Dr. Schmidt said, because trials

and meta-analyses in the medical litera-

ture show conflicting data on both sur-

other therapeutic avenues be explored

for patients with locally advanced esoph-

ageal cancer.Carl R. Schmidt, MD, a research fel-

low in surgical oncology, Department

of Surgery, Vanderbilt University Medi-

cal Center (VUMC), reported the results

on behalf of colleagues from VUMC,

Vanderbilt-Ingram Cancer Center, and

Substantial Dose Sparing of Cochlea

With Conformal Proton Radiotherapy

Substantial Dose Sparing of Cochlea

With Conformal Proton Radiotherapy

Mainfile A_ vs FINAL.pmd

05/06/2004, 2:12 PM

1

MAY 2004

VOLUME 18 • NUMBER 5

For ONCOLOGY on the Web, visit www.CancerNetwork.com

Lung Cancer ScreeningWith WW Spiral CT: Towarda Working StrategyReviewed by Robert A. Smith; and

Claudia I. Henschke and David YankelevitzPSA After Radiationfor Prostate CancerReviewed by Mack Roach III

Radioimmunotherapy:A New Treatment Modalityfor B-Cell Non-Hodgkin’sLymphomaLL

Reviewed by Gerald L. DeNardo and Sally J. DeNardo;

Andrew M. Evens and Leo I. Gordon; and Mark S. Kaminski

Surgical Cytoreductionin Ovarian CancerReviewed by Scott M. Eisenkop andAnnekathryn Goodman

Nonepithelial Malignanciesof the BreastReviewed by Syed A. Hoda; and

Stephen G. Wallace and Lori J. GoldsteinPlus Current Clinical Trialsof 17-AAG and 17-DMAG

Full contents on pages 551, 555, and 556

Wayne A. McCreathDennis S. ChiMemorial Sloan-KetteringCancer Center

Deborah A. KubanKKHoward D. ThamesLarry B. LevyThe University of TexasM. D. Anderson Cancer Center

Elizabeth E. WarneraaJames L. MulshineGeorgetown University HospitalNational Cancer Institute

Irene GhobrialThomas WitzigWWMayo Clinic andMayo Foundation

Rashmi ChughLaurence BakerUniversity of MichiganComprehensive Cancer Center

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