Physical Examination

Physical examination of the breast remains an important technique to screen for breast cancer, since approximately 1 in 10 breast cancers will not be seen on mammography.  This should be performed by a skilled professional at least once a year after approximately age 18.  Most lumps are not cancerous, and in fact, many times what seems to be a lump is really just an area of lumpiness in the breast itself.  (It is hard to believe, but breast tissue itself is usually quite hard and nodular when it is exposed at surgery.)

The characteristics of a lump are very important in determining how it should be managed:  Most important is whether the lump persists, since conditions that "come and go" are almost never associated with cancer.  This is especially true if the area appears just before the menstrual cycle, and then completely disappears afterwards. 

In addition to feeling for lumps, it is important to look for areas of skin change such as a persistent area of redness or skin dimpling.  Also, nipple discharge which is bloody and comes on its own needs to be evaluated, since this may be due to a developing cancer.  On the other hand, nipple discharge which is green, tan, milky and comes from several ducts in both breasts is almost never associated with cancer.

Skin changes that occur on the nipple itself may also be a sign of early breast cancer called "Paget's disease."

Finally, masses that have been present for years require periodic re-evaluation even if they have been "checked out" in the past, as it is difficult to determine whether or not there are serious new changes which may be developing in that area.