by Patricia Bailey

If there was only one thing I could convey to women about their health it would be the significance of breast screening. During my 30 years as a breast surgeon, I’ve seen the difference that early detection can make. According to the American Cancer Society, women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health.

Current evidence supporting mammograms is even stronger than in the past. In particular, recent evidence has confirmed that mammograms offer substantial benefit for women in their 40s. Women can feel confident about the benefits associated with regular mammograms for finding cancer early.

Women, ages 20-40, should have a clinical breast exam (CBE) by a health professional preferably every three years. And, starting at age 40, women should have a CBE every year. Breast self-exam (BSE) is an option for women starting in their 20s.

During self-exams, if you feel a lump in your breast, it’s understandable to be concerned. But don’t jump to conclusions. Instead, take action. Call your doctor to find out what it is. Also, make sure you are not mislead by myths about breast lumps.

Myth: A breast lump is probably cancer.

Most breast lumps women feel — 8 out of 10 — aren’t cancer. It’s more common for them to be a cyst (a sac) or a fibroadenoma (an abnormal growth that’s not cancer). Some lumps come and go during a woman’s menstrual cycle. Truth is — You can’t tell what it is by how it feels.

Myth: There’s nothing you can do to lower your breast cancer risk.

While you can’t change certain risk factors — like being female and having a family history of breast cancer — you can do a lot to help reduce your breast cancer risk as much as possible. In a word: lifestyle. Exercise more and eat healthier, especially if you’re overweight or obese. Limit or eliminate alcohol and quit smoking. Cancer prevention isn’t fool-proof, but being responsible about your health can go a long way.

Myth: You don’t need mammograms after menopause.

Getting older is not a reason to skip regular breast health checks. In fact, your risk of developing breast cancer goes up as you get older. About two out of three invasive breast cancers are found in women age 55 or older. As long as you’re in good health and would be a candidate for treatment, you should continue getting mammograms.

Myth: if you have a lump but your mammogram is normal, you’re done.

You may need more tests, such as an MRI, ultrasound, or follow-up mammogram, to take another look at the lump. You may also need to get a biopsy, which is when a doctor takes a small sample of the lump to test it. Your doctor may also recommend getting checked more often.

Myth: Cancerous breast lumps are always painless.

Not necessarily. Although breast cancers aren’t always painful, having breast pain doesn’t rule out cancer. Inflammatory breast cancer — which has early symptoms such as redness, swelling, tenderness and warmth in the breast — can be painful when there is a lump.

Myth: A small lump is less likely to be cancer than a large lump.

Breast lumps come in all sizes, and size doesn’t affect the odds that it’s cancer. Even small lumps can be aggressive cancers.

Myth: If you feel a lump soon after a mammogram, it’s OK to wait another year.

Call your doctor if you notice a lump soon after your latest mammogram, even if the results were normal. Mammograms can miss some cancers, especially if you have dense breast tissue or if the lump is in an awkward location (such as near your armpit).

Myth: A lump is probably harmless if there’s no breast cancer in your family.

Many women think they’re not at risk for breast cancer if no one in their family has had it. But that’s not true. Less than 15 percent of women with breast cancer have a relative who’s had the disease, according to the American Cancer Society. Get all lumps checked by a doctor, whether or not breast cancer runs in your family.

Patricia Bailey, M.D., is a breast surgeon and medical director of the Chestnut Hill Hospital Women’s Center (Blue Bell and Chestnut Hill). The Center is a Certified Quality Breast Center of Excellence offering health care for all stages of a woman’s life including nurse navigator; low-dose, digital mammography; ultrasound; bone density (DEXA) screening; and therapeutic massage. Meet Dr. Bailey at the free Pastorius Park Summer Concert series on Wednesday, July 16 at 7 p.m. Bring your questions and visit the Chestnut Hill Hospital booth.

  • MichelMn

    Women should not be misled by the disinformation on mammography in this article.

    The biggest clue for women to see what’s going on is that it is nearly always big profiteers of mammography, such as radiologists, oncologists ,or surgeons, who keep telling women to go have mammograms. These conflicts of interests are also heavily present in the pro-mammogram “studies” where the harms are downplayed, and among cancer charities.

    Bailey makes misleading claims like “Current evidence supporting mammograms is even stronger than in the past.” Fact is past evidence in support of mammography was weak and flawed (but the mammogram business forced its global introduction of it) and it is still weak and flawed today. What’s happening is that slowly and finally more and more of the actual truth of screening is coming out, which is in disfavor of the test, which has the medical industry scrambling to put out even more propaganda in support of screening.

    If you want to get an account as close as possible to the truth about screening you need to read “Mammography Screening: Truth, Lies and Controversy” by Peter Gøtzsche, and “The Mammogram Myth” by Rolf Hefti.

    Bailey’s sound bite is the typical propaganda of the big business of organized medicine.

  • Jenee Binet

    How about you learn how to spell “misled”?

  • Mammacare

    A medical colleague in Philadelphia forwarded to me this interesting report that was published in your journal. I hope my response is useful to you and your readers,

    Mark Kane Goldstein, Ph.D., Senior Scientist, MammaCare

    Dr. Bailey, corrects several important misunderstandings about breast cancer detection. Almost daily my colleagues and I learn of women who, after self-detecting a lump, were sent home by their physician because their mammogram was negative, only to return in 6 months with more advanced cancer.

    Dr. Bailey accurately addresses this frequent error. Her advice in this regard is valuable and potentially life saving.

    Both mammograms and personal exams produce false negatives and false positives as the data confirm. In both cases the errors are strongly associated with the training, experience and procedures of the radiologist or clinician performing the breast exam. It is also true that for young women, whose breast tissue is dense, the evidence indicates that palpation skills are the most valuable method of early detection and that mammograms should not be performed. .

    A problem is that most women and physicians have not learned to perform effective, standardized, clinical or personal breast exams.

    The body of evidence on this subject concludes that breast cancer screening depends more on superior training for hands and eyes than on technology, and that the common practice of screening is deficient in one or both of these critical areas, as Dr. Bailey’s report suggests.


    Here are a few of the related findings with annotated excerpts below each

    A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J. Surg 2010 Dec; 200(6): 712-7. Haakinson DJ, Stucky CC, Dueck AC, Gray RJ, Wasif N, Apsey HA, Pockaj B.

    “Patients presenting with palpable masses on SBE or CBE even with a normal mammogram within 1 year tended to have more aggressive tumors… resulting in more aggressive therapy.”

    Breast cancer presentation and diagnostic delays in young women. Cancer. 2014 Jan 1;120(1):20-5. doi: 10.1002/cncr.28287. Nov 11. 2014 Ruddy KJ, Gelber S, Tamimi RM, Schapira L, Come SE, Meyer ME, Winer EP, Partridge AH.

    “Most young women detect their own breast cancers…”

    Palpable presentation of breast cancer persists in the era of screening mammography. J Am Coll Surg. 2010Mar; 210(3): 314-8. Mathis KL, Hoskin TL, Boughey JC, Crownhart BS, Brandt KR, Vachon CM, Grant CS, Degnim AAC.

    “Patients with palpable presentation were younger than those with screen-detected cancer (mean age 57 versus 62 years…).”

    Discovery of breast cancers within 1 year of a normal screening mammogram: how are they found? Ann Fam Med. 2006 Nov-Dec; 4(6): 512-8. Carney PA, Steiner E, Goodrich ME, Dietrich AJ, Kasales CJ, Weiss JE, MacKenzie, T.

    “Having a lump and both a personal and a family history of breast cancer was the most common reason why women initiated a health care visit.”

    Does This Patient Have Breast Cancer? The Screening Clinical Breast Examination: Should It Be Done? How? Journal of the American Medical Association, 1999 Oct, 6: 283(13), 1687-9. Barton, M.B., Harris, R. & Fletcher, S.W.

    “…MammaCare’s standards for teaching and practicing effective CBE emerged from an extensive series of laboratory studies measuring lump detection and breast examination skills using tactually accurate breast models embedded with small, simulated lesions.”

    How best to teach women breast self-examination. A randomized controlled trial. Annals Intern Med. 1990 May 15;112(10):772-9. Fletcher SW, O’Malley MS, Earp JL, Morgan TM, Lin S, Degnan D.

    “Mammacare instruction resulted in more long-term improved lump detection and examination technique use than did traditional instruction or physician encouragement. Breast self-examination instruction should emphasize lump detection skills. “

    Please forgive any spelling or syntax errors in this response


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  • sydsinger

    I am a medical anthropologist breast cancer researcher, and co-author of Dressed To Kill: The Link Between Breast Cancer and Bras. Wearing tight bras each day is a leading cause of breast cancer, due to constriction of the breast lymphatics. This information has been publicized now for over 20 years, and several studies support this, and yet the mainstream cancer industry still refuses to deal with this issue. We are calling for a boycott of the Susan G. Komen Foundation and the American Cancer Society for their irresponsible dismissal of the bra-cancer link. When they come asking for donations, send them your bra instead. For more on the boycott and the bra-cancer link, go to my website KillerCulture dot com.