European Stars and Stripes (Newspaper) - October 22, 1991, Darmstadt, Hesse                                Self exam Banat Sale exam nation should to Dono ones o month. Familiarity Makaa it a alar to not Lea Ehan Gaa in tha Banat. Early la ovary of a Changa from what la a Normal Quot la tha reason for Sale Agama. If you menstruate the beat time for a Salt exam la two or Throe Days after your period ends when your breasts an least Likely to be tender or swollen. If you do not menstruate plea a Day such As the tint Day of the month to remind you that it is time for a self exam. 7 stand before a a Mirror. Inspect both breasts for anything unusual such As any discharge from the nipples puckering dimpling or scaling of the skin. The next two Steps Are designed to emphasize any change in the shape or contour of your breasts. As you do them you should be Able to feel your Chest Muscles tighten. 2 watching a closely in the Mirror clasp hands behind your head and press hands Forward. 3 next press hands a firmly on hips and Bow slightly toward your Mirror As you pull your shoulders and elbows Forward. Some women do the next part of the exam in the Shower. Fingers Glide Oxer soapy skin making it easy to concentrate on the texture underneath. 4 raise your left Arm. Use a three or four fingers of your right hand to explore your left breast firm it carefully and  at the outer / Edge press the Flat part / of your fingers in / _ Small circles moving / the circles slowly around the breast. A gradually work toward the nipple. Be sure to cover the entire breast. Pay special attention to the area Between \ the breast and the armpit including the armpit \ itself. Feel for any unusual Lump or mass under the skin. 5 gently sur the the a nipple and look for a discharge repeal the exam on sour right breast. 6 Steps i and o should be Rei it Euton Lynn a Down. Lie Flat on your Back left Arm Oxer your head and a Pillow or folded to Vel under your Lett shoulder. This position flattens the breast and makes it easier to examine use the same circular motion described earlier. Repeat on your right breast. . Dept of a attn breast Cance r a new look at the value of self exam by Daniel q. Haney a science writer cancer experts have exhorted two generations of american women to Check their breasts for lumps each month because it makes sense. Who would doubt that finding tutors earlier save lives the idea seemed so logical in fact that it has Only recently been subjected to careful scientific testing. And the results these scientists say Point to a surprising conclusion breast self examination seems to do Little to prevent death from breast cancer. They say women who Check their own breasts do indeed find cancer sooner a but apparently not soon enough to make a significant difference. By the Lime breast lumps Are big enough for women to feel there is a Good Chance the cancer already has spread 1o other parts of their bodies the scientists say. But even it breast self exams truly fail to save lives a and experts vehemently disagree on this Point a the medical world is divided Over what women should be told. Some contend that even marginally effective Home screening has value it can prevent at least some deaths from cancer it finds tutors at a smaller size so women have less disfiguring surgery and it gives women a sense that they Are doing something to control their own fates. And most of All it does no harm. Or does it the sceptics contend that the heavy promotion of a worthless screening method diverts attention from mammograms a test that truly does save lives. They fear that some women who examine themselves May be lulled Inlo thinking they can avoid mammograms entirely. A we certainly done to know that we should Tell women to Stop Quot said or. Noel Weiss of the University of Washington. Quot All we can say is that As it is currently practice breast self examination is not doing much to reduce the mortality from breast  Weiss is a co author of a study published in february in the journal of the National cancer Institute that attempted to assess its value. Researchers compared the self screening habits of 209 women with advanced breast cancer and 433 randomly selected women without breast cancer. They found no difference. Their conclusion breast self examination Quot As practice by most Seattle area women is of Little or no Benefit. Quot doctors in great Britain conducted a different Experiment to ask the same question. They showed 63,630 women How to do self exams while 127,117 were Given no special help. Over the next seven years the risk of dying from breast cancer was the same in both groups. Quot if you re going to be really scientifically Tough you be got to say that in terms of survival there is no difference Quot said or. I. Craig Henderson director of the breast evaluation Center at the Dana Farber cancer Institute in Boston. However others contend these statistical studies Are flawed. Because so Many women do breast self exams it is difficult to find comparison groups who Are not performing them. And since about 60 percent of All breast cancers Are discovered by women themselves they say the notion that women gain nothing by finding them sooner rather than later defies reason. Quot i think we should pay no attention Quot to the studies said or. Charles smart chief of the cancer Institute s Early detection Branch. Quot i done to think they prove  smart believes women should be encouraged to examine their breasts regularly however he like other experts cautions that these exams Are no substitute for regular mammograms which find tutors Long before they can be detected by touch. Some of the most powerful arguments in favor of self exams come from women who believe they Are living proof that they work. In january their value became stunningly Clear to or. Sally Faith Dorfman a gynaecologist from Cornwall n.y., who is the Orange county health commissioner. When Dorfman routinely examined herself just As she did every month or two her fingers Felt a bump the size of a Small Lima bean just under the skin on the Bottom Edge of her left breast even though a Mammogram six months earlier had found nothing wrong she showed the Lump to her own physician. The doctor thought it was probably a harmless sebaceous cyst but recommended having it taken out anyway. Debate continues Over surgical method by Raymond Hernandez Cox news service i in june 1989, Marigrace Ryan a life hinged on a decision a one that became harder to make As she got advice from her doctors. Ryan had breast cancer and the doctors were divided Over How if should be treated. One recommended a Mastectomy a removal of the whole breast. The other physician urged a breast sparing Lumpectomy followed by radiation therapy. The Dayton Ohio woman was t sure who to listen to and put the decision Oil for three weeks. She worried that the Lumpectomy might not be successful but did no to want to lose her breast. Quot i was very confused during that time Quot Ryan 39, recalled. She finally chose the Lumpectomy and radiation a year later when her cancer recurred she had a Mastectomy. Ryan s Case underscores a dilemma laced today by Many women with breast cancer Progress in Dot Ecim Early stage tutors has led to disagreement among medical professionals Over How breast cancer should be treated. For decades the Mastectomy was the Standard breast cancer treatment. The trauma of losing a breast was outweighed generally by the procedures proven Success rate. Today some doctors favor Lumpectomy for Early stage cancer treatment. Its a vital Issue to women in 1991, 175,000 american women will be diagnosed with breast cancer according to the american cancer society 44,500 women Are expected to die from it. Some general guidelines have been set for treating Early breast cancer. In 1990, the National cancer Institute said the combination of Lumpectomy a in which Only the tumor axillary Lymph nodes and the immediate surrounding tissue Are removed a and radiation therapy is appropriate treatment. It also said that that approach is As effective As a Mastectomy. What a More some studies have shown that patients with breast sparing therapy such As Lumpectomy and radiation had belter images of their bodies than those who had Mastectomy. The need to preserve the patients self image figures prominently in medical literature and most doctors seem sensitive to it. Nonetheless some medical professionals have been slow to accept breast conserving treatment. For instance a male doctor inclined to do a Mastectomy May see a woman s desire to preserve her breast As frivolous when measured against the Mastectomy s Success rate said or. Margaret m. Dunn a general surgeon at Miami Valley Hospital in Dayton. Some male surgeons figure a i m Here to protect my patient from doing anything silly Quot Dunn said. Historically Radical mastectomies a which May involve removing not just the breast but also some of the connective muscle fat and Lymph tissue a were done because it was believed that breast cancer started with a breast tumor and spread to the Lymph glands under the arms and throughout the body. The Mastectomy was done to prevent that spreading. Mastectomies Are still the most widely used but treatment of Early stage breast cancer in America varies from one Region to another. For example Lumpectomy and radiation therapy Are used More in the Northeast and on the West coast than in the South and Midwest. And it s been estimated that Only 20 percent of the women who Are eligible for a Lumpectomy have had the procedure. In february a surgeon removed the Lump. Inside a layer of fat was a tiny White growth the size of a by shot. The pathology labs conclusion infiltrating Ducal carcinoma. Breast cancer. Dorfman said she has been assured that because she discovered the growth so Early she has a better than 90 percent Chance of a full lifespan. She believes her self exam quite literally saved her life. Quot this is a Cass where intuition overpowers science Quot she said. Quot if you feel something before you re due for a Mammogram and you get it taken care of sooner you be got to be ahead of the game. It is counterproductive and perhaps irresponsible to put so much importance on statistical results that Are probabilities and not absolutes when we All know so Many of these anecdotes Quot even if breast self exams do not help Many women live longer experts agree that finding lumps while they Are still relatively Small helps women avoid the most feared treatments for the disease Dorfman for instance underwent removal of the Lump and surrounding tissue which should heal with hardly a Trace and she will undergo six weeks of radiation therapy. If her tumor had been larger she might have required More extensive surgery such As a Mastectomy or chemotherapy. Some experts believe that while breast self exams actually can save lives it happens so infrequently that the Benefit does not show up in studies. Henderson guesses that the exams May reduce mortality by 4 percent or 5 percent. But even an advantage this Small could result in Many lives saved considering the Large number of women at risk the american cancer society estimates that 175,000 women will by diagnosed with breast cancer this year and 44,500 will Efie from it. By the late 1970s, it was determined that the Radical Mastectomy often Wasny to necessary because research changed the understanding of the Way the cancer spread. It s now thought that Early stage cancer cells travel invisibly through the blood and Lymph to other parts of the body. Thus treatment now focuses on removing Only the tumor and limiting the spread with the use of therapies such As radiation chemotherapy and hormone treatments. Quot i done to feel a patient should have to lose a breast if the lesion is Small enough Quot said or. Robert Field a radiation oncologist at Miami Valley Hospital. Quot by detecting the breast cancer earlier you have More  that s not to say the breast preservation approach is the answer in All cases. For one thing women whose cancer develops in several locations within a single breast Are not the Best candidates for Lumpectomy. Neither Are women whose tutors Are Large in relation to their breast. A Lumpectomy would t produce Good cosmetic results in such a Case. Patients should get educated enough through consultations with their radiation oncologist and surgeon 5o make a valid decision on their own Quot Field said. Military mammograms available throughout Europe by Anita Gosch staff writer Mamm graphic screening devices Are available at 16 military medical facilities throughout  areas where military hospitals or clinics do not have the devices arrangements Are made with civilian health care professionals. In some cases women Are air evacuated to military hospitals that provide the service. There is no charge to military members and their families for Mamm graphic screening pay patients Dod civilians generally pay the Standard fees for a doctor s consultation. The five air Force facilities that have the machines perform 240 mammograms a month. About 550 women a month get the screening at the army s nine facilities and about 100 a month use the devices at the Navy s two facilities. The american cancer society recommends that every woman have an initial Mammogram Between the Ages of 35 and 40. Women Between 40 and 49 should have a Mammogram every year or two and women Over 50 should have them annually. The reason for this is the clearly demonstrated effectiveness of mammograms. Having them regularly reduces the breast cancer death Rale by about 30 percent mammograms Are not perfect they miss perhaps 10 percent of cancers and this is one reason some health care professionals contend that physical examination of the breast always will be necessary. Barbara Bower health risk educator Al the army clinic in Darmstadt Germany is among health professionals urging women to perform routine monthly breast self examinations. Quot if you have never done a breast self exam and Are unsure of How to do it have your physician show you How Quot she wrote in a recent report. In recognition of october being National breast cancer awareness month military medical facilities throughout Europe have been placing special emphasis on women a health. The gynaecology clinic at Frankfurt army regional medical Center arranged 300 special 15-minute Well woman appointments during october. The appointments which were fully booked by september included Pelvic exams Pap smears and breast examinations. Mammograms were to be scheduled if the need was indicated from the routine appointment. Air Force hospitals throughout Europe also Are offering special programs this month including lectures and seminars on breast cancer detection educational briefings and audio video presentations on the proper procedures Tor breast self exams. Booklets and other handouts Are also available. The following army hospitals and clinics in Germany have Mamm graphic screening devices Lan Stuhl. Bad Cannstatt. Augsburg Bremerhaven fran Turl Heidelberg Nurnberg and Wurzburg. A machine also is available at the army clinic in Vicenza Italy. The Navy hospitals in Rota Spain and in Naples Italy have the machines. The Branch naval Hospital in Simonella Italy does not have a Mammogram machine but refers patients to local civilian facilities. The following air Force facilities have mammography capabilities Raf Lakenheath and Raf upper Heyford in the u k., Torrejon a in Spain and Ramstein a and Wiesbaden Hospital in Germany army pee. Melissa a. Wolfal operates a mammography unit at Frankfurt Germany. S&5 gut Schuz to la a Page 14 b the stars and stripes tuesday october 22, 1991 the stars and stripes b Page 15