Edited by Mirabella Chan
As an initial disclaimer, we recognize that not all people with breast anatomy identify as a woman, however we will use the term “woman” or “women” in the body of this article to describe genetic females. And while breast cancer is more common in genetic females, genetic males may also be impacted.
First, what is breast cancer?
Breast cancer, like many other types of solid cancers, is characterized by uncontrolled cell growth and division as well as dysfunctional cell death signalling pathways. These abnormal processes disrupt the important balance between cell death and cell division typically present in the body’s tissues. Breast cancer often starts in breast ducts (“ductal carcinoma”) or lobules (“lobular carcinoma"). Breast cancer begins in a localized area of the breast but can spread to other areas of the body. Specific subsets of breast cancers express certain receptors (e.g., HER2-positive breast cancer) or are hormone related (e.g., estrogen receptor (ER) positive and progesterone receptor (PR) positive breast cancer). Knowing these factors helps to guide specific treatment.
Women should know to look for hard, immovable lumps in breast tissue and signs of abnormal nipple discharge. It should be noted however, that the identification of a lump does not confirm nor deny a cancerous group of cells. Further evaluation is required to identify whether any abnormal tissue is cancerous. Locally advanced breast cancer can present with enlarged lymph nodes in the armpit or skin changes such as redness, thickening or a specific dimpling of the skin called peau d’orange.
Breast Cancer Screening
Screening programs are crucial for identifying patients who have cancer, even in patients who have not yet developed symptoms. Regular screening also allows for early treatment initiation before the disease becomes widespread. Screening mammography is used in Canada, which is a specific x-ray of the breast from different angles.
The Canadian Cancer Society provides the following recommendations for breast cancer screening:
Age 40--49: Talk to your doctor about your risk of developing breast cancer, as well as benefits and limitations of getting a mammogram
Age 50--74: Get a mammogram every 2 years
Age 75+: Talk to your doctor about whether it is appropriate for you to get a mammogram
Women who are at higher risk for developing breast cancer may deviate from these recommendations and may get a mammogram at a younger age or more frequently compared to women without specific risk factors.
These risk factors include:
Family history of breast cancer
Gene mutations such as BRCA1 (BReast CAncer gene 1) or BRCA2 (BReast CAncer gene 2)
Personal history of breast cancer
Dense breast tissue
Previous radiation therapy to the breast or chest
How to Perform a Breast Exam
The benefit of breast self-examinations is controversial, with some research suggesting that that self-screening does not reduce mortality associated with breast cancer and can sometimes cause more worry than needed, leading to unnecessary tests. However, this screening modality can still be considered to help women become more familiar with breast changes and speak with their doctor if they have concerns.
Breast self-exam tips:
Remove clothes above the waist
Lie down - this helps spread your breasts evenly to make lumps/changes easier to feel
Check the entire breast using the pads of your three middle fingers, using opposite hands for each breast (right hand for left breast, left hand for right breast)
Using either an up and down pattern or a spiral pattern, feel from your collarbone to the bottom of the bra line and from your armpit to your breastbone
Use different levels of pressure depending on the type of tissue: light pressure for tissue close to skin surface, medium pressure for deeper tissue, and more firm pressure for tissue close to your breastbone and ribs
Avoid lifting your fingers from your skin during your examination. Gliding over the skin surface while applying pressure can aid in feeling for lumps or any changes
Follow this 6-step guide to complete a thorough breast exam:
The importance of regular screening along with self-breast examinations should not be understated. It is never too late to start! We hope that this guide has helped shed some light on the proper method of examination and screening recommendations. Although October is Breast Cancer Awareness Month, it is important to spread awareness and continue the conversation about breast cancer. It can save lives.
Breast cancer basics. Canadian Breast Cancer Network. https://cbcn.ca/en/what-is-breast-cancer. Accessed March 16, 2022.
Joe BN. Clinical features, diagnosis, and staging of newly diagnosed breast cancer. In: Post T, ed. UpToDate; 2021. Accessed March 15, 2022. www.uptodate.com
When should I be screened for breast cancer? Canadian Cancer Society. https://cancer.ca/en/cancer-information/find-cancer-early/get-screened-for-breast-cancer/when-should-i-be-screened-for-breast-cancer. Accessed March 16, 2022.
Klarenbach S, Sims-Jones N, Lewin G, et al. Recommendations on screening for breast cancer in women aged 74 years who are not at increased risk for breast cancer. Can Med Assoc J. 2018;190(49):E1441–E1451. doi: https://doi.org/10.1503/cmaj.180463
Romito K, Gabica MJ, Thompson EG, Chen WY. Breast self-examination. MyHealth.Alberta.ca. https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=hw3791&lang=en-ca#hw3791-Bib. Updated February 11, 2021. Accessed March 18, 2022.