Self examination of the breast
Breast Health
Breast Health issues | healthy lifestyle | points | prevention | self exam | investigations

 

Self-Examination of the breast

 

Remember

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Breast cancer usually presents as a lump in the breast that is painless.

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Nine out of ten breast lumps are benign and not cancer.

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It follows that one in ten breast lumps is a malignant growth (cancer).

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Cancer of the breast is today a curable disease if detected and treated early.

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Nine out of ten breast lumps are noticed by women themselves.

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It is not difficult to examine your own breasts.

 

Every woman should know the texture and consistency of her breasts. They must, in other words, know what their breasts feel like. They must also know how the texture and consistency of the breast changes with the menstrual cycle. The breast tends to be engorged, firmer and slightly tender, just before the onset of menstruation. All breasts are different however some tend to be lumpier while others are smooth.

 

Who should examine their breasts?

Every female from puberty, and certainly from eighteen years of age, should examine her breasts.

 

When and where?

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Breasts should always be examined at the same time of the menstrual cycle. It is usually recommended that you examine them at mid-cycle i.e. ten days after your period terminates. Post-menopause, you should examine your breast on the first weekend of each and every month. This must be a regular occurrence, like brushing your teeth twice a day.

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The best place to check your breasts is in front of the mirror just before your bath. Breasts should be examined while standing up and lying down. The older one gets the more flat one should lie in order to counter the effects of gravity. The larger the mirror the better, but the mirror should be able to show at least a reflection of your trunk and head region. A skin oil rubbed onto the breasts may facilitate the self-examination.

 

How?

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Use the flat surface of the hand. Keep the hand flat on the breast and gently flex the fingers onto the breast.

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Use your left hand to examine your right breast. Use your right hand to examine your left breast.

 

Note:

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The breast is arbitrarily divided into four quadrants and the sub-areola (beneath the nipple and areola) region.

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The axillary tail (of Spence), which is the region of the breast between the breast proper and the armpit (axilla) i.e. the bridge of breast tissue between the breast and the axilla.

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The axilla itself.

The following steps should be followed:

 

Step I

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Stand in front of the mirror and look at your breasts.

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Now lift your arms above your head, as though you are trying to touch the ceiling with both hands and look at your breasts in this stretched position.

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Check that there are no differences between the two sides and whether there are any nipple changes or visible lumps.

 

Step II

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Now palpate (feel) all five breast regions described above.

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Feel the axillary tail (area of the breast extending to the armpit).

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Palpate each axilla; most of the nodes are felt between the axillary skin and the rib cage using the appropriate fingers (the volar aspect of the middle three fingers of the right hand) to examine your left axilla and vice versa.

 

Step III

What do you look for and what do you feel for?

1. A lump

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May vary in size from a marble to a tennis ball.

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May be seen in the mirror or it may be palpated (felt).

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May be painful or not.

2. Changes of the skin of the breast

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Puckering is where a cancer may invade the overlying skin and pulls it inwards (best seen by lifting the arms away from the body.)

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Tethering is where a cancer may be attached to the overlying skin (when you move the lump, the skin pulls "inwards").

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Dimpling is where a cancer invades the ligaments of Cooper, causing a malignant fibrosis and contraction of the ligament; this also pulls the skin finely inwards, but here the lump is usually not as close to the skin as in puckering or tethering (notice this as a small dent on the skin when moving the arms or breast).

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Skin ulcer.

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Peau d'orange or orange peel appearance of the skin (this is due to the cancer blocking the breast lymphatic channels, causing a lympoedema or fluid retention and swelling of the breast (the hair follicles or skin pores give the orange skin appearance)).

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Hot, red inflamed breast.

3. Changes on the nipple

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If a recent inversion of the nipple is experienced, it may mean that a cancer under the areola is pulling the nipple inwards.

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If nipple inversion has been present since birth, it is called a congenital inverted nipple and has no special significance except for its cosmetic appearance.

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The benign problem of duct ectasia may also cause nipple retraction.

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Eczema of the nipple (Paget’s disease) If the patient has developed such exzema recently, has no other history of eczema, and there is no other area of eczema on her body, then this may be the first sign of an underlying cancer that is spreading to the nipple via the milk ducts.

4. Changes in the glands or armpit

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Enlargement of the nodes in the axilla or in the neck above the collar bone (supraclavicular nodes).

5. Changes in size and shape of breast over a short period of time

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Enlargement of one breast.

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Normally one breast may be slightly larger than the other, but this will always have been so since puberty or after breast feeding; if it is recent, there may be an underlying breast disease.

6. Enlargement of one arm

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Lymphoedema (an accumulation of fluid in the tissue taht causes swelling) of the arm may be due to extensive metastatic involvement of the ipsilateral (same side) axilla with breast cancer, thus blocking the normal lymph drainage of the arm.

7. A discharge from the nipple

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Feel beneath the nipple for duct thickening, rolling the ducts between finger and thumb.

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BulletA clear or greenish discharge is almost always innocent.

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A spontaneous discharge(occurring without you squeezing the nipple) is concerning and you should seek medical advice.

8. A few points need to be emphasised

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Multiple lumpiness in the breasts usually indicates cyclical lumpiness (fibroadenosis).

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Sometimes a plaque or area of thickening is discovered that is not a discreet lump. Such a plaque should be viewed in the same way as a lump in the breast, although it is even less likely to be cancer than a lump is.

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Remember that most lumps are benign or innocent; so if you find a lump in your breast, do not be afraid to go to your doctor.

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An ultrasound is a non-invasive device that can aid the clinical examination particularly if you have lumpy breasts.

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Be extremely circumspect about taking advice from unqualified people, breast cancer management is a specialised field with new management techniques being introduced on a fairly regular basis.

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Remember the earlier a breast cancer is detected the easier it is to prevent from reoccurring.

Patients are entitled to obtain advice from any source they believe may be able to help them. We recommend that patients seek evidence based (scientifically accepted) treatment. Some patients prefer to see a physician with a special interest in breast disease who can work with their beliefs and with other healers.