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A routine mammogram is the most effective tool in detecting early breast cancer; however, physicians at Mount Auburn Hospital also encourage women to have a thorough physical exam every year in conjunction with their mammogram.

Susan Pories, M.D., breast surgeon at Mount Auburn Hospital in Cambridge, a teaching hospital of Harvard Medical School, says women should try to become familiar with their own bodies and advises women to not delay if there are changes or questions regarding their breast health.

She advises women to perform self-breast examinations every month. For pre-menopausal women, Dr. Pories suggests doing this after the menstruation cycle; for post-menopausal women, the first of the month is recommended. Women should try to become experts in their own breast exam. “It’s crucial that women are comfortable looking at and examining their own breasts, as well as seeing their primary care provider or specialist for an annual physical exam,” says Dr. Pories. “Women shouldn’t hesitate to see their physician if they have any questions or concerns.”

The first step in a self-breast exam is to look in the mirror. Women should watch for asymmetry or swelling of the breast or a change in the shape of the breast. It’s also important to check for dimpling of the skin or a sore that doesn’t heal. Other skin changes to look for include discoloration, redness, or thickening of the skin. The skin can also take on a porous appearance, similar to that of an orange peel. . These skin changes can be a sign of inflammatory cancer, a rare form of breast cancer and should be investigated by your physician. Signs of another unusual type of breast cancer called Paget’s disease can appear around the nipple with itching, scaling and irritated skin which can be easily mistaken for eczema. Nipple inversion and spontaneous clear or bloody nipple discharge can also be signs of breast cancer. These more unusual signs of breast cancer are often missed or mistaken for something else.

The next step in the breast exam is to check for lumps or thickening. Lumps can feel like a small pea or ball inside the breast and are usually hard to the touch. However, Dr. Pories says sometimes cancer can grow like fingers, spreading throughout the breast, so the breast will be thickened or asymmetrical. The self-breast exam should include checking the underarm area as well. “The tail of the breast goes up under the arm, so sometimes breast tissue will be felt there too as well as the lymph nodes which respond to changes in the breast, which means a lump in the underarm should always be evaluated.” says Dr. Pories.

If you notice any of these abnormalities on your exam, Dr. Pories encourages you to consult your nurse practitioner or physician. The doctor may order other diagnostic tests such as an ultrasound or breast MRI and refer you to a breast specialist for evaluation and biopsy Biopsies are simple procedures to test the breast tissue and ensure that cancers are not missed.

While the majority of breast cancer patients are women, men can develop the disease as well. According to The American Cancer Society, 1,600 men will develop breast cancer this year. The evaluation process for men who find a lump or notice nipple discharge is similar to that for women.

Changes can be subtle, so to take charge of your breast health, Dr. Pories has the following recommendations:

1. Be aware of your own anatomy – perform a monthly self-breast exam. If anything looks or feels different to you, call your physician right away.

2. Get screened regularly – the baseline for mammograms starts at age 35 with annual screenings beginning at age 40.

3. Know your family history – a family history of breast or ovarian cancer increases a woman’s risk for developing breast cancer. It’s important to know the age women in your family were diagnosed as this will affect when screening should begin. Dr. Pories says if a mother was diagnosed with breast cancer at age 40, her daughter should begin mammogram screenings when she is ten years younger - at age 30.

4. Genetic counseling – if there is a strong family history, it may be prudent to consider genetic testing for the breast cancer gene mutations. Dr. Pories says there are preventative medications and therapies for women with a high risk for developing the disease.

5. Reduce alcohol intake – alcohol works to release estrogen, a known source for most breast cancers, from the liver. Limit alcohol beverages to no more than one or two a day.

6. Avoid taking estrogen supplements - talk to your doctor about alternative strategies for managing menopausal symptoms.

“As a hospital, we have a warm, welcoming feeling. Our primary care physicians and nurse practitioners will talk openly with you about your concerns and examine you in a respectful and caring fashion,” says Dr. Pories. “Through our coordinated services at The Hoffman Breast Center and patient advocate, Beth Roy, we will do all we can to make sure that your experience will be positive.”

For a free breast self-exam shower card, please call us at 617-499-5094.

Mammography, breast ultrasound, ultrasound breast biopsy and stereotactic breast biopsy and programs are accredited by the American College of Radiology. We are licensed by the Massachusetts Department of Public Health and have a valid Certificate of Inspection.