breast health check

After the age of 25, have a clinical breast examination every year, after the age of 35, have a breast ultrasound every year, and after the age of 40, have a mammography every 1 to 2 years.； If you have a family history of breast cancer or a history of moderate to severe atypical hyperplasia of the breast, it is enough to advance the starting age of screening 10 years and find a specialist to customize a personalized plan.

A while ago, I met a 32-year-old primary school teacher in the clinic. He said that he had been doing monthly breast self-examination for 5 years and had never felt a lump. The results of the ultrasound examination showed that there was a BI-RADS category 4a nodule of 2cm in the right breast. It was located deep and hidden behind the gland. He couldn't feel it by himself. Fortunately, it was benign when it was punctured and it was fine after it was cut. Many people have read popular science that breast self-examination is the first line of defense. This is actually true. However, in recent years, the direction of domestic and foreign guidelines has actually changed - the original promotion of "regular and standardized self-examination" has now mostly been changed to "cultivating breast health awareness." It’s not that self-examination is useless, it’s that ordinary people have not received professional palpation training. They either mistake normal hyperplastic glands for nodules and go to the emergency room all night because of fear, or such deep or relatively small nodules cannot be touched. Instead, they relax their vigilance because “I have self-examination and there is no problem”, which delays screening. When you take a shower, you can just touch a few of them. If you feel something strange, a hard lump, or a sudden discharge from your nipple, or a sunken skin, you should go to the hospital immediately. You don’t need to set an alarm and spend half an hour every month doing a "standardized self-examination". It will be like completing KPIs, but instead make you anxious.

When it comes to screening projects, what many people are most afraid of is the mammography target. Not only does it hurt, but they are also worried about the radiation. Can they just not do it without doing it? This actually depends on age. Most women under the age of 40 have dense breasts. The glands are as dense as dough buns, and the rays from the mammography target cannot pass through them. The films taken are all white, and no lesions can be seen at all. The procedure is in vain, and they consume more radiation for nothing. Two weeks ago, a 27-year-old girl came to me with the mammography list issued by the physical examination center and asked me if she wanted to do it. When I saw that she was young and had no high-risk factors, I just asked her to withdraw and just do an ultrasound. But after the age of 40, women's glands slowly shrink and are replaced by fat, and mammography can clearly see them. Especially for early-stage intraductal cancer, many times the nodules cannot be felt at all, and there are no symptoms. Only mammography can capture the characteristic micro-calcifications, which cannot be replaced by ultrasound. As for the radiation that everyone is afraid of, the radiation dose of a single mammography target is about 0.3mSv, which is lower than the cosmic radiation you receive on a 10-hour long-distance flight. It is completely within the safe range, so don’t worry too much.

Many medical examination institutions now also promote breast thermal imaging and breast cancer genetic testing. Are these IQ taxes? In fact, it cannot be beaten to death with a stick. For example, thermal imaging. Some niche studies believe that it is more sensitive to inflammatory breast lesions and tumors with rich blood supply. However, all current mainstream breast cancer screening guidelines do not list it as a routine screening item. The false positives are too high. I have seen many people who were found to be "high risk" by thermal imaging. They came to do ultrasound mammography and nothing happened, and they were anxious for half a month. As for BRCA gene testing, if there are more than two direct relatives in the family who have suffered from breast cancer or ovarian cancer, or a male relative has breast cancer, it is highly recommended. If a mutation is found, not only can it be screened in advance, but preventive treatment can also be carried out. But if you are an ordinary healthy person with no related medical history in your family, there is really no need to spend thousands to do this. Even if the risk is found to be slightly higher, is it possible that you can still have your breasts removed? On the contrary, being frightened every day and being in a bad mood can more easily stimulate breast gland problems.

I have been in the breast department for almost 8 years, and I have seen two of the most extreme types of people. One type is people who don’t take it seriously at all. They have never had a breast screening in their 40s, and the pain is unbearable. It’s a pity that it’s already in the advanced stage. The other type is excessive anxiety. For type 3 nodules, it is enough to check them once every six months. If you have to order an ultrasound every month, you are afraid that the nodules will become malignant. Instead, because of poor sleep every day and emotional stress, the nodules have grown almost 1cm in six months. In fact, the breast is a particularly "emotional" organ. The more nervous you are, the more likely it is to cause problems. Just follow the rhythm of the screening and there is no need to cause trouble for yourself.

All in all, breast health check-up is really not a complicated matter. Just like your annual dental cleaning and annual cervical cancer screening, it is an insurance for your own health. It does not need to be demonized or despised. Oh, by the way, before doing the screening, try to avoid the 3 days before menstruation. At that time, the glands are congested and edematous. Whether it is palpation or ultrasound, it is easy to make errors. It is best to go 3-7 days after menstruation is clear, so as to avoid a wasted trip.