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    Understanding Breast Problems -- The Basics

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    Breast Self-Exams and Mammograms

    You should discuss breast self-exams with your doctor, and your doctor should go over how to perform them with you. Premenstrual changes can cause temporary thickening in breast tissue that disappears after your period, so your doctor may tell you to wait until a few days after your period to do them.

    A breast self-exam is easiest in the shower, using soap to smooth your skin. Look for dimpling. Using light pressure, check for lumps near the surface. Use firm pressure to explore deeper tissues. Squeeze each nipple gently; if there is any discharge -- especially if it is bloody -- consult your doctor.

    Any time you find a new or unusual lump in your breast, have your doctor check it to make sure it is not cancer. Most lumps are harmless. The best test for distinguishing a cyst from a solid tumor is ultrasound; a needle biopsy may also be done.

    Mammograms -- detailed X-ray pictures of the breasts -- can reveal tumors too tiny to be felt by hand. There is disagreement as to when a woman should start getting mammograms: Some doctors say between ages 35 and 40; others say not until age 50. The American College of Obstetricians and Gynecologists recommends yearly mammograms starting at age 40. The National Cancer Institute recommends a mammogram every 1 to 2 years, starting at 40. The American Cancer Society recommends them after age 45. The USPSTF recommends routine screening for women starting at 50. If you have a family history of breast cancer, especially in your mother or sister, your doctor may want you to start them earlier. Three-dimensional mammograms, to be used along with traditional digital mammograms, are also available in some screening centers.

    Breast Pain

    Breast pain can have many causes, including the normal swelling of breast tissue during the menstrual cycle. Other causes include infection or injury; growths, including cancer; and perhaps diet.

    The general swelling of breast tissue with your period can be painful, but it is not dangerous, and no treatment is necessary if you can tolerate the discomfort. Each monthly cycle brings about changes in hormones, including more estrogen and progesterone, that bring more fluid into the breasts, expanding tissue, stretching nerve fibers, and causing pain. Some women have this painful swelling just before their periods, with symptoms easing near the end of the menstrual flow. Others have it as a side effect of birth control pills.

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