9 3 Definition Methods of breast cancer detection including breast self-examination, clinical breast exami- nation by a health care provider, and mammography (X-ray study of the breast). The exact cause of breast cancer is unknown. Breast cancer is believed to develop in response to a number of interrelated factors. (See Risk Factors, page 10.) Excluding skin cancer, breast can- cer is the most common cancer among women in the United States and is second only to lung cancer as the leading cause of cancer-related deaths. Characteristics Important symptoms that might indicate breast cancer include changes in the look or feel of the nipple or breast. This could include the contour of the breast dimpling, scaling, or puck- ering of the skin around the nipple nipple inversion discharge from the nipples a lump or thickening color changes redness any other changes from what has been normal. Because 25 percent of cancers of the breast occur in defined risk groups, screening for breast cancer should be applied to all asymptomatic women. (See the Breast Cancer Detection Guidelines on page 10.) Policy Evaluate in the occupational health unit any employee with symptoms of breast cancer and refer for further medical evaluation or mammography. Objectives Clinical Assessments and Interventions Referral for Medical Action Breast Cancer Detection 9 • Previous diagnosis of cancer. • Symptoms of breast cancer. Follow-up Actions • If examination findings are nega- tive, counsel employee regarding importance of monthly breast self- examination (see the figure on page 11), regular checkups with health care provider, and mam- mography as indicated. • If examination findings are positive: – Collaborate with health care provider regarding diagnosis and follow-up. – Emphasize importance of med- ical treatment and follow-up. – Provide employee with emo- tional support. • Counsel employee about rehabili- tation and return to work. Obtain pertinent history. Examine employee breasts. Advise regarding further evaluation. • Inquire about symptoms (see Characteristics above), previous breast disease, dietary habits, menstrual history, family history, trauma to area, and breast self-examination findings. • Inspect breasts with the employee’s arms at the sides and overhead and with hands on hips. • Palpate each breast using the circular or oval pattern, the vertical strip, or the wedge pattern. Palpate regional lymph nodes in supraclavicular fossa and axilla. • Arrange for medical evaluation with the employee’s physician or mammography im- mediately if any abnormality noted.