What is the Breast made of?

Structure of the breast

While breasts can come in all shapes and sizes, the breast is usually pear shaped. The breast tissue extends from the second rib to the fold under the breast to the outside of the armpit and rests against the chest muscles. About one third of breast tissue is made up of fat.

Each breast has a nipple with milk duct openings. Around each nipple is a darker area - this is called the areola.

The breast tissue is made up of lobes and lobules that produce the milk. The milk flows through ducts that spread like a vine inside the breast connecting the lobes with the duct openings in the nipple.

Ducts are common sites for breast cancer. Only about 10% of breast cancers occur in the lobes.

Circulatory System

The breast also contains arteries, veins, nerves, lymph nodes, and lymph vessels. Breast cancer can spread through the lymph vessels and veins to other parts of the body.

The main vein is the mammary vein. Most of the smaller veins drain into this vein. Some veins drain into areas under the armpit, or along the ribs. The blood stream can help spread cancer cells from the breast to other organs in the body.

Lymphatic system

The lymphatic system carries waste from cells in a fluid called lymph. Lymph nodes throughout the body filter waste.

Breast cancer often spreads to the lymph nodes first. The lymph nodes usually involved are in the axillary or under arm lymph nodes, these nodes are used as an indicator for further treatments. Other areas can be the internal mammary nodes or the supraclavicular lymph nodes near the collar bone.

When the cancer cells have spread the process is called metastasis.

Priorities in Breast Awareness

The Foundation recommends following the three priorities in breast awareness:

1. Mammogram
2. Know your breasts
3. Your family doctor

The aim of the priorities is to detect a breast cancer early on, if it develops. It is important to be breast aware as the earlier breast cancer is detected, the more likely you will survive the disease.

The New Zealand Breast Cancer Foundation has a free ‘Priorities in Breast Awareness’ card about breast self checks which you can view or download by clicking here. You can also request a printed copy by phoning 0800 902 732, or by Email .

Priority One - Mammogram

A screening mammogram is the best method for the early detection of breast cancer in ‘well women’; women who have no signs or symptoms of breast cancer.

The Foundation recommends a screening mammogram for women as follows:

40 – 49 years every year (For further information click here)
50 years onwards every two years

Free Screening Mammograms - BreastScreen Aotearoa
The Foundation strongly supports the National Screening Programme, BreastScreen Aotearoa, which provides free screeningmammograms to women 45-69 years of ageevery two years. To register for this programme, Phone: 0800 270 200 or visit www.nsu.govt.nz

Free Diagnostic Mammograms
Women at any age who have suspicious signs or symptoms of breast disease are eligible for a publicly funded (free) diagnostic mammogram at a NZ District Health Board (DHB) service. A referral from your doctor is required to enable you to access this service.

Priority Two - Know your breasts

The Foundation recommends women become aware of how their breasts look and feel:

Know what is normal for you
Know what changes to look and feel for

Changes in the breast that require attention:

A new lump or thickening
A change in breast shape or size
Puckering, dimpling or a change in the colour of the skin
Any change in a nipple such as, a discharge or a nipple that starts to turn inwards

Remember:

You are looking and feeling for any new or unusual change - a change that is different, not normal for you
Discuss any concerns you have about your breasts with your family doctor
Nine out of ten lumps are not cancerous (benign)

What a lump may feel like
Lumps can feel hard and irregular, or they can feel smooth. A suspicious lump is usually hard and irregular in shape – a bit like a raisin. It may be attached to the surrounding tissue or skin, so it doesn’t move around easily. A non-cancerous lump feels more like a grape (smooth edges and more rounded); however, if you find any unusual lumps get them checked by your family doctor immediately.

Breast self checks
By checking your breasts, you get to know how your breasts look and feel. Therefore, you will increase your likelihood of early detection of breast cancer, if it should develop.

The The New Zealand Breast Cancer Foundation recommends women do breast self checks from 20 years of age. Women who carry out breast self checks become aware of what their normal breast looks and feels like, and if breast cancer did develop, at some time during their lifetime, hopefully, they will have more of a chance of detecting it. There are examples of many women being ‘breast aware’ and finding their own lumps (either unfortunately before the age for mammograms, or unfortunately, when a mammogram hasn’t picked it up).

If you wish to check your breasts, good places to do this are:

In front of a mirror
In the shower or bath

There isn’t really a right or wrong way to check your breasts, as long as you get to know your whole breast area up to your collarbone and under your armpits – well enough to notice any possible changes.

Lump sizes

	2 mm This is the size of the smallest cancer found by regular mammography
	14.5 mm Average size of cancer found by regular mammography
	15.6 mm Average size of cancer found by a first mammogram
	22 mm Average size of cancer found by chance

Note: circle sizes for demonstration purposes only. Size of circle on screen may be affected by your computer settings.

Priority Three - Your Family Doctor

The Foundation urges women at any age to consult their family doctor if they have the slightest concern about their breasts:

Discuss your need for a clinical breast check

The Foundation recommends women have an annual clinical breast check from the age of 40 yrs

Discuss your personal risk, particularly if you have a family history of breast or ovarian cancer

Women who are at high risk, for example, have a strong family history, may be eligible to receive a free screening/diagnostic mammogram at a District Health Board (DHB) service, if they are outside the free screening age range. Talk to your family doctor about your options.

Summary

Be Breast Aware	20-39 years	40-49 years	50+ years
1. Screening mammogram
2. Do breast self checks
3. Clinical breast check by your family doctor

The Foundation encourages women to make breast awareness part of their life. Mammography, breast self checks and discussing any concerns with your family doctor all contribute to the likelihood of detecting breast cancer early. Until breast cancer can be prevented, we need to be pro-active about the priorities in breast awareness.