There is some controversy on the subject of self-examination. Advocates say that it encourages early diagnosis and therefore an increased chance of early treatment. Those against it say that self-examination does nothing to prevent the disease in the first place and also leads to a lot of unnecessary worry for the great majority who find symptoms which turn out to be benign. I fall into the first camp and believe wholeheartedly that self-awareness in relation to physical symptoms is an integral part of taking responsibility for your own health.
One of the purposes of self-examination is to become aware of what is normal for your body. The object is not to compare yourself to what is normal for other women. Everyone is a different size and shape, with a different nipple type, and the person who is best placed to diagnose changes is the expert – you! Ninety per cent of breast cancers are detected by the women themselves. Mammography in the fifty-plus age group detects very early stage breast cancers, but by far the majority of tumours are still found by the women themselves.
In order to monitor the health of your breasts it is advisable to do a breast check yourself once a month. Ideally, women should start this routine in their late teens or early twenties and continue the habit for life. Breast examination is free, encourages self-awareness, and is the way that most breast lumps are found. This is how to do it:
1. Examine your breasts when you have a quiet moment and the time to do the check properly. It is best to examine your breasts in the week after your period, as hormonal changes prior to your period will probably make the tissue thicker or lumpier, and thus less easy to notice irregularities. Post-menopausal women can make a routine of examining their breasts on the same day every month – the first is easy to remember. If you have had a hysterectomy which has left your ovaries intact, you may be experiencing the stages of your menstrual cycle without accompanying bleeding – in this case choose a regular monthly time when your breasts are not swollen or sensitive.
2. First stand in front of a mirror with your arms by your side, observe the shape of your breasts and determine if there is any change from the last examination. Lean forward and observe any changes. Come upright again and move your arms horizontally to the side and then over your head. All the time you are looking for changes in how your breasts move, in the texture of the skin, for any dimpling or puckering. Look for changes in the nipples as well, such as change of direction or pulling-in.
3. While standing in front of the mirror, physically examine your breasts. This can be done either in quadrants, like the slices of a pie, or in ever-larger circles from the nipples out. Remember to feel under the armpits and also to examine the nipple by pushing downwards with one finger and gently squeezing the nipple to check for any discharge. You should also check above your
collar-bone.
4. Repeat the physical examination while lying down on your back. Raise one arm, rest it comfortably under your head and use the opposite hand to check your breast. Many women find it ideal to examine their breasts in the bath or shower as the skin is then slippery. The whole procedure may take a bit of time at first, but after three or four months you will find it can be done much faster
- but not too fast! Thoroughness is important and the examination is a few minutes of time well invested.
5. If you do find a lump or any other symptom, it is important to have it checked by your doctor as early as possible. Early diagnosis is one of the key factors in increasing the chance of survival. However, do not panic – for every five lumps one is cancerous, and the remainder are benign and harmless. Even if a lump is cancerous, six or seven out of ten will be treated without the removal of the breast – the greatest fear for some women.
It is important, for the best chance of early diagnosis, to get away from the idea that you are always looking for a lump. Symptoms that can be a warning of breast cancer are:
-    A lump in the breast or any area of thickening
-    A lump in the armpit
-    Change in the size or shape of the breast
-    Inversion (pulling-in) or puckering of the nipple
-    A rash around the nipple
-    Bleeding or discharge from the nipple (especially one-sided)
-    Dimpling or puckering of the breast skin
-    Swelling of the arm
-    Ulceration of the skin
-    Breast pain or persistent tenderness
-    Unusually prominent veins on the breast
Even if you have had symptoms where breast cancer has been ruled out previously, say
non-malignant breast lumps, you should follow through with any concerns since benign breast disease can co-exist with breast cancer. One does not indicate the other, but neither does one preclude the other.
If you are pregnant, or breast-feeding, your breasts will be undergoing many changes, but monthly examinations are still wise as 3 per cent of all breast cancers are found in women who are either pregnant or breast-feeding. If there are any symptoms that concern you it is best to seek your doctor’s advice.
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