The Three-Stage Approach to Screen for Breast Cancer

The pink ribbon, the universal symbol of breast cancer awareness, makes us pause and think when we see it. We think of our mothers, sisters and friends who have been affected by this disease.

One in eight women are diagnosed with breast cancer every year, and eighty percent of the cases reflect no family history of the disease. That pink ribbon serves as a beacon to remind us to seek early detection, by getting a mammogram, seeing a doctor and doing monthly checks. For many women, this is the last thing we’re thinking about. All of us savvy gals have busy lives and this doesn’t seem like a priority.

One gal in particular didn’t make it a priority in time. Leanne is the energetic single mother of two boys, Robby, 14, and Alex, 11. Her life is busy with her nursing career, taking the boys to their sporting events and just trying to keep up. This all came to a crashing halt in May of 2006, when she discovered a lump. Leanne had been faithful about going in for her yearly gynecological exam, but the referrals to get a mammogram lay forgotten on her desk. As she began calling her doctor to take the next step, she looked at the referrals and felt an overwhelming sense of sadness and regret. “I knew that if I had just gone in for a mammogram this lump would have been discovered the year before,” she said, “and I would be at a different point in my life right now.”

Detection is the key

We’ve all heard it before, but let’s say it again; early detection can lead to a better outcome when dealing with cancer. The Susan G. Komen for the Cure organization is a great place to discover valuable information about breast cancer. This group is the result of a promise between sisters. Nancy G. Brinker promised her dying sister, Susan G. Komen, that she would do everything in her power to end breast cancer forever.

The information on the nonprofit’s Web site recommends a three-step approach to breast cancer screening, which includes a combination of mammography, clinical breast exams and breast self-exams.” They suggest annual mammograms beginning at age 40 and a clinical breast exam at least every 3 years beginning at age 20, and annually from age 40 on.

We all know that we should be performing a monthly self-examination, but do we really know what we’re doing? Having a clinical exam done at a yearly gynecological appointment might be the best place to start. Your physician or nurse can demonstrate how to do a self-exam and explain what changes of which you should be aware. And in the meantime (not meant as a substitute for a professional’s advice) you can watch a video or follow an instruction card online.

The American Cancer Society has these suggestions on what to look for in your monthly exam:

“If a change occurs, such as development of a lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. Should you notice any changes you should see your healthcare provider as soon as possible for evaluation. Remember that most of the time, however, these breast changes are not cancer.”

Leanne admits she wasn’t very consistent with self-exams, “I went in for my yearly appointment, but didn’t remember on a monthly basis to do them at home.” When she began experiencing pain and found the subsequent lump, she thought, “I’ve killed myself. I knew there were things I could be doing to screen for breast cancer, but I thought that happens to other people. It’s a shock when you realize that it’s your turn.”


In the United States, in order to make sure mammograms are safe and being run by qualified people, the Mammography Quality Standards Act was created. The National Cancer Institutes explains the act this way, “The Mammography Quality Standards Act (MQSA) is a Federal law designed to ensure that mammograms are safe and reliable. Through the MQSA, all mammography facilities in the United States must meet stringent quality standards, be accredited by the Food and Drug Administration (FDA), and be inspected annually.” Countries around the world have taken similar steps to ensure the safety of mammography.

We’ve all heard the stories about the procedure itself: the “vise,” and the “squishing.” Katrin Wooldrige, a registered radiologist in radiography mammography said that everyday she hears the same thing, “I have women who come in and say, I hate this, I hate you, and I don’t want to be here. I don’t enjoy having them done either, and, know this is invasive and not fun; but, I also know it saves lives.”

RN Linda Kottmann advises women to set up an appointment at a time during the month that can minimize the discomfort. She recommends right at the end of the menstrual period through that first week after the period for menstruating women.”

A radiologist with special training in mammography will then read the x-ray. If something questionable is discovered, additional procedures will be needed. Linda explains, “Depending on what is found and the patients own personal history, the next step could be a sterotactic needle biopsy, or an ultrasound, or even an evaluation with a surgeon who has experience with breast abnormalities — meaning a physical exam and review of the mammogram.”

Leanne had several procedures after her mammogram. In the end she was diagnosed with stage-two breast cancer and had a bi-lateral mastectomy and six rounds of chemotherapy. It has been a painful year for Leanne and her children. “I look back on pictures of myself before I knew about the cancer, and think, I had cancer and didn’t even know it.” Because of her own journey Leanne strongly urges women to get a mammogram, do self-exams and see the doctor. “It can’t be said enough; early detection makes all the difference.”

Start the habit now

Pick a day during the month to do a self-exam, and call and remind a friend. Make it a monthly habit. Download the cards and hang them up on a mirror or laminate them and place them in your shower. There is nothing like a daily reminder to keep us aware of what we need to do to stay healthy.

When you begin having mammograms, get into the routine of making the appointment. Wooldrige shared, “Many women come in on their birthdays to do their mammograms.” This is one day a year you can’t forget. Make an appointment for your gynecological exam at the same time and get everything done for the year. Then treat yourself to lunch!

Helpful Websites: Susan G. Komen for the Cure at; American Cancer Society at; and National Cancer Institute at


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