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        A part from skin cancer, the breast is the most common site of cancer in women. It is second only to lung cancer as a cause of death from cancer among women. The probability of developing the disease increases throughout the life, says Dr S Sathyanarayanan of Sage Surgical Centre, Nanganallur, a suburb in Chennai..

        Though the incidence of breast cancer continues to increase, mortality has seen to decrease. This is due to both early detection and increased use of systemic therapy. Women whose mothers or sisters had breast cancer are three to four times likely to develop it and the risk is further more in patients whose mothers' or sisters' breast cancers occurred before menopause or were bilateral and in those with a family history of breast cancer in two or more first-degree relatives.

        A woman who has had cancer in one breast is at increased risk of developing the same in the other breast. Breast self-examination has not been shown to improve survival. Despite this and despite possible increased biopsy rates, it is a useful technique since many patients do detect their own cancer, and women often feel more in control and proactive by using this procedure.

        All women over age 20 should be advised to examine their breasts monthly. Pre-menopausal women should perform the examination 7-8 days after the menstrual period. The breasts should be inspected initially while standing before a mirror with the hands at the sides, overhead, and pressed firmly on the hips to contract the pectoralis muscles. Masses, asymmetry of breasts, and slight dimpling of the skin may become apparent as a result of these manoeuvres. Next, in a supine position, each breast should be carefully palpated with the fingers of the opposite hand.

        Mammography

        Mammography is the most useful technique for the detection of early breast cancer. Mammography is the only reliable means of detecting breast cancer before a mass can be palpated. Slowly growing cancers can be identified by mammography at least two years before reaching a size detectable by palpation. New computer-aided film reading may aid in diagnosis but is not routinely performed at the centres with experienced mammographers.

        Diagnostic tests

        Biopsy: The diagnosis of breast cancer depends ultimately on examination of tissue or cells removed by biopsy. Treatment should never be undertaken without an unequivocal histologic or cystologic diagnosis of cancer. The safest course is biopsy examination of all suspicious masses found on physical examination and of suspicious lesions demonstrated by mammography.

        Ultrasonography: Ultrasonography is performed chiefly to differentiate cystic from solid lesions. Though not diagnostic, ultrasound may reveal features highly suggestive malignancy such as irregular margins on a new solid mass. This may show an irregular mass within a cyst in the rare case of intracystic carcinoma. If a cyst is aspirated and the fluid is non-bloody, it does not have to be examined cytologically. If the mass does not occur, no further diagnostic test is necessary.

        Mammography: When a suspicious abnormality is identified by mammography alone and cannot be palpated by the clinician, the lesion should be biopsied by computerised stereotactic guided core needle technique. Other imaging modalities are automated breast ultrasonography, ductography, MRI (Magnetic Resonance Imaging and PET scanning.

        Cytology: Cytologic examination of nipple discharge or cyst fluid may be helpful on rare occasions. As a rule, mammography (or ductography) and breast biopsy are required when nipple discharge or cyst fluid is bloody or cytologically questionable, Dr Sathyanarayanan says.