How to do a Breast Self Exam

So, you have decided to do a regular self examination of the breast but are not sure how to get started? Here's a simple way to do it. Don't be overwhelmed by the pictures. Read through. It's really simple to do.

Like I mentioned in a previous post, there is no fixed or best method of doing a breast self exam. The only thing you must remember is to examine all areas of your body that are likely to contain breast tissue. And examine this area very carefully and thoroughly. Remember missing out a small change for a long time can be really bad.

Area to examine when doing a breast examination

So which area should you examine? I repeat - examine the whole of your chest (the front and the sides as well) and the armpit. I just love this picture. It shows the entire area you must examine.

From the collar bone to the bra line and from the middle of the chest to the sides, including the armpit...that's the area you need to examine.

Examining the breast is not rocket science. It is as simple as examining a pimple on your face. What do you do? You look at it in the mirror and then feel it with your hand. That's exactly what you do with your breasts.

Looking for changes:

In a well-lit room, stand in front of the mirror with your hands by your side. Look at the front of your chest. Compare what you see on either side. Then turn to the left and then to the right. Examine the sides.

Once you are convinced there is no new change, try out these positions. In each position, remember to check not just the front but also the sides. 

This is all you need to know about looking for changes. Simple, isn't it? The next is feeling for changes in your breasts.

Feeling for changes:

There are several different methods to feel for changes in your breasts and you may try out all or any of them. Here's one method that I believe covers the entire area and thickness of the breast. If you follow this single method, you should be able to detect changes in any area of your breast.

Lie down on a bed with a pillow/folded towel under the left shoulder if you wish to examine the left breast first. Keep your left hand folded at a right angle as in the picture here.

In this position, the entire breast spreads out flat and is of almost the same thickness throughout making it easier to examine.

Feel your left breast using the flat or pulp of the three middle fingers of your right hand. At each place where you put your fingers, make three coin-sized circles with your fingers.

Why three circles? Well, in order to apply three different pressures while feeling for lumps.

One pressure should be light enough to move the skin without moving the tissue underneath. Then apply a medium pressure so you can reach midway into the tissue. And then apply a deep pressure so that you can reach your ribs. These three different pressures allow you to reach different thicknesses of your breast tissue. See the adjoining pressure to know what I mean.

At each place, use these three different pressures in circles to check for changes. Without lifting your fingers, slide them and check another area of the breast. If you lift your fingers, you are likely to miss out some areas of the breast.

How do you slide the fingers? In which pattern? I follow a simple stripe pattern that covers the entire area of the breast.

Start from the armpit. Keep sliding down till your bra line. Then move a little medially (towards the middle of the chest). Keep sliding up till you reach the collar bone. Move medially again and come down to the bra line...Keep repeating till you reach the middle of the chest.

After you have done this, don't forget to let your arm loose and check in the armpit for lumps.

Then check your nipple for changes or any abnormal discharge. And before you know it, you have thoroughly checked for changes in one breast. Repeat all the steps in the other breast.

With some practice, you should be able to check your breasts in less than 5 minutes. And you need to check for changes only once in a month. So that's not much, is it?

Know your breasts well so that you can detect any change at the earliest. If you detect any abnormality, do not panic. Most lumps or changes in the breasts are not cancer. But they do need attention and treatment. So see a doctor in time.

Early Detection of Breast Cancer

Breast cancer - it certainly is not a death sentence! Cancer is a group of over 200 different diseases that result due to uncontrolled divisions of cells in the body. But luckily enough, breast cancer is a condition that can be easily detected at an early stage and treated adequately.

The survival rates of breast cancer are some of the best. The most commonly used term to describe survival rates is the 5-year survival rates. The 5-year survival rate refers to the percentage of patients who live for at least 5 years after their cancer is detected. Many live much beyond that. In fact, my grandmother lived for over 18 years after her breast cancer was detected and when she finally died, her death was not related to her cancer.

The 5-year survival rate for breast cancer that is detected early can be higher than 90%. Check the American Cancer Society's data on breast cancer survival.

Now, how do you detect breast cancer at the earliest? It's an easy 3-step method.

• Breast Self Exam

This is a simple technique which you can do at home. Just pay attention to any changes in your breasts. Look and feel for changes in your breasts. There are several different methods to do this. You really do not need to bother much about all the different methods. Just remember you need to look and feel for changes on the entire area of your body that contains breast tissue.

This includes an area that starts from your collar bone on top to your bra line at the bottom, from the middle of the chest to the side of your chest (including your armpit). Here's a picture that should tell you where to examine for changes.

Remember that breast tissue spreads much beyond just the protruding bulge.

When you examine just the bulging part you tend to miss out on many other areas where breast tissue is found. In fact, breast cancer is commonest in the outer upper quadrant of the breast which does not have much of a bulge.

How often should you do a self exam? Once a month should be sufficient. Start once you are 20 years of age and continue doing a self exam throughout your life. Make it a part of your regular life.

• Clinical Breast Exam

This is about getting your breasts examined by a clinician. 

Get a clinical exam done once in three years if you are less than 40 years old. Once you are above 40 years, go for an annual checkup with a clinician. 

Who should you go to? Ideally, it should be a surgeon who has been examining a lot of breasts and can detect changes early. But you can get yourself examined even by your gynecologist or your family physician. Just get yourself examined regularly. 

• Screening Mammography

This is a special x-ray of the breast. It helps detect minor changes in the architecture of the breasts. An annual screening mammography is recommended for women above 50 years of age. If your mammograms are normal, you may go for a screening mammography every two years. 

Mammography does not seem to help younger women much. However, if your clinician suspects a change in your breast, he/she may advise you to get a mammography done at a younger age. Do not defer from getting a mammography done in that case. 

Please remember to do a regular self-exam, in addition to, not in place of clinical breast exam and a mammography. When you combine all the three different methods for screening, you are more likely to detect cancer at its earliest. 

If you have never gone for a breast cancer screening. This is an excellent time to start. Get started!

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P.S. The pictures used here are from various sites derived after a Google search. I used them because I felt they gave an apt description of what I wanted to convey. If you have any issues about my use of these pictures, please write to me.  

20 Myths About Breast Cancer

“But nobody in my family has breast cancer...”

“You are too young to have cancer.”

“Thank God I am a male...”

Have you often heard these lines and wondered if these people were actually safe?

October is the Breast Cancer Awareness Month. Let us increase our awareness about breast cancer by trying to differentiate the myths from the facts. A part of this list had been published in 2008 on EzineArticles. But this is a more extensive list. 

1.    Men do not get breast cancer.

Men are lucky but not totally immune to breast cancer. In rare cases, men may get breast cancer. For every 100 women with breast cancer, only one man may get it. If they notice any unusual change in their breasts, men should consult their healthcare providers without too much delay.

2.    Breast cancer occurs only in elderly ladies in their postmenopausal age.

Recent trends in metros show younger women falling prey to breast cancer. It is not very uncommon to find ladies in their 30s being diagnosed with breast cancer. It can even happen to girls who are just 15-16 years of age. No age is immune to breast cancer.

3.    The family history from only the mother’s side is important.

If somebody from your mother’s side of the family has breast cancer you have a higher chance of having it too. However, the history of breast cancer in the father’s side of the family is also important. In about 5% of cases, breast cancer may have genetic link. Such genetic traits may be transmitted from either the father or the mother’s side.

4.    Nobody from either side of my family ever had breast cancer. So my family history is not really significant.

Not just a history of breast cancer...a history of ovarian or prostate cancer in the family is also important. If somebody in the family had either of these cancers, the risk of breast cancer is also increased among members of the family.

5.    Nobody in my family ever had any kind of cancer. So, I am safe.

Not really! Family history is just one of the multiple factors that can increase your risk of breast cancer. There may be other factors involved that can increase your risk of breast cancer.

6.    Breast cancer always presents as a lump in the breast.

A lump in the breast is one of the most common presentations of breast cancer. However, the condition can also present as any unusual change in the breast such as

• Swelling of all or part of the breast
• Skin irritation or dimpling
• Breast pain
• Nipple pain or the nipple inversion
• Redness, scaliness, or thickening of the nipple or breast skin
• A nipple discharge other than breast milk
• A lump in the underarm area

7.    All/most breast lumps are cancer.

Nearly 8 out of 10 breast lumps are benign and not cancerous. Benign lumps in the breast may be due to cysts, lipomas, fibromas etc.

8.    Breast cancer is painful.

In most cases, breast cancer presents as a painless lump. That is the main reason why women tend to delay consulting a doctor. For an early detection of breast cancer, it is important that we encourage women to seek medical advice for just about any change they notice in their breasts, whether or not it is painful.

9.    A painful breast lump is not cancer.

If a breast lump is painful, it is more likely to be due to a benign condition. Most cancerous lumps in the breast are painless. But pain alone cannot rule out cancer.  A painful breast lump CAN BE cancer.

10.  An injury to breasts can cause cancer

An injury to the breast does not cause cancer. It may simply draw attention to an underlying lump that may eventually be diagnosed as malignant. If the breast is bruised badly, there may be an accumulation of blood under the skin that can feel like a lump. The body will reabsorb this over time, just as any bruise heals. Sometimes an injury may cause fat necrosis. The body’s repairing mechanism may cause a firm scar over it. This may be visible on a mammogram as a solid lump. Further investigations often rule out cancer.  

11.  Fibroadenomata are benign tumors and do not increase the risk of cancer.

Fibroadenoma is a benign tumor to start with. However, it is a long-term risk factor for breast cancer. The risk is increased in women with complex fibroadenomas, proliferative disease, or a family history of breast cancer.

12.  If there is no lump seen in a mammogram, it means there is no cancer.

A mammogram is a sensitive investigation to detect a lump. However, ‘no lump’ in a mammogram does not mean ‘no cancer’. In early stages of breast cancer, there may be no lump. Only microcalcifications and parenchymatous changes may be seen.

13.  Annual mammograms expose you to radiation and thus increase the chance of cancer.

Mammography does expose a woman to some amount of radiation. It is at a level far below any regulatory limits. However, if a woman is pregnant she should notify her health care provider prior to having a mammogram. Also mammograms should be avoided in women who haven’t reached menopause unless there is a real need for one. Routine annual screening mammograms are recommended only for women in the peri- and postmenopausal age group.

14.  Mammography is painful.

Mammography does cause a little discomfort to some women when the breasts are slightly pressed between the plates of the X-ray machine. However, mammography per se is not painful unless the woman has a painful cyst already present. To avoid any pain or discomfort, it is best to get a mammography done a couple of days after the menstrual bleeding stops as some women complain of tenderness in the breasts prior to their menstrual periods.

15.  Birth control pills are dangerous as they increase the risk of breast cancer to a great extent.

The pill has gone through many permutations since its invention. Earlier pills used much more estrogen and progestrerone than today’s pills do. Earlier findings of an increased risk of breast cancer are not necessarily applicable to the pill used today. ‘Total months of use’ and the time when it is used are also important factors. There is a small increase in risk of breast cancer if the pill is taken before the first full term pregnancy. According to the Society of Obstetricians and Gynecologists, for every 10,000 women who use OCPs, there would be:

·         About 2 additional cases of breast cancer if OCP was used before the first full-term pregnancy

·         About 1 additional case of breast cancer if OCP was used after the first full-term pregnancy.

Also, 10 years after stopping the birth control pill, a woman's risk of breast cancer appears to be the same as a woman who never used OCPs. Thus, in the Indian context, OCPs do not pose a major problem of increasing the risk of breast cancer. Population control is a bigger issue here!

16.  In that case, hormone replacement therapy (HRT) is also safe and does not increase the breast cancer risk significantly.

Study published in New England Journal of Medicine, Feb 2009, says postmenopausal women who take combined estrogen plus progestin HRT, for at least five years, are doubling their risk of breast cancer. It also says that women can quickly reduce their risk of breast cancer by stopping HRT. This fall in risk occurs within one year. Menopause is a physiological change and if HRT can be avoided, it is should not be prescribed.

17.  Wearing an underwire bra or wearing a bra at night increases the risk of breast cancer.

It is a rumor that underwire bras block the drainage of lymphatic fluids from the bottom of the breast and that this leads to the breast tissue being ‘soaked’ in toxic fluids which increase the risk of cancer. There is no scientific evidence to support this claim. In fact, the lymphatics from the breast drain upwards towards the arms and not downwards where they can be blocked by the pressure of an underwire bra.

18.  Size matters! Women with small breasts have less chance of getting breast cancer.

There is no connection between the size of the breast and the risk of getting breast cancer. It is more difficult to examine very heavy breasts than to examine smaller breasts. But irrespective of the breast size, all women need to go for regular screenings and check- ups along with the monthly self-examination.

19.  If you are at risk of breast cancer, there is nothing much you can do other than watching out for signs of cancer.

Even if you are at risk of breast cancer, there is a lot you can do to lower the risk.

·         If you are obese, exercise regularly.

·         Lower or eliminate consumption of alcohol.

·         Be rigorous about examining your breasts and having regular clinical exams and mammograms.

·         Preventive medications such as tamoxifen are also available. But they are accompanied by several side effects.

20.  Breast cancer is preventable.

Sadly, no! Breast cancer is not completely preventable. It is possible to identify risk factors and make lifestyle changes in order to decrease your risk. However, nearly 70% of women diagnosed with breast cancer have no identifiable risk factor. The disease occurs largely due to ‘as-yet-unexplained’ factors.

So, what’s in your hands? A regular self-exam, clinical exam and screening that can help in early detection of cancer! Once detected, do not panic. Get yourself a timely and adequate treatment.