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Self-examination: breast cancer
April 01 , 2013
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Breast cancer is cancer formed in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare. Breast cancer is the most common cancer in women.

 The most effective way of detecting breast cancer is by mammography and a clinical breast examination to check for changes (such as lumps or thickening). It includes looking at and feeling the breasts. When breast cancer is detected in its early stages, chances of surviving the disease are greatly improved.

Steps

Inspection

Start by standing undressed from the waist up in front of a large mirror in a well-lit room. With your arms relaxed by your sides, look closely at your breasts. Don’t be alarmed if they do not look equal in size or shape. Most women’s breasts aren’t. 



 With your hands on your hips :

- Check to see if they are their usual size, shape and color.

- Check if they are evenly shaped without distortion or swelling

- Check if the nipple has changed position, whether there is an inverted nipple(nipple retraction) and if so, is it unilateral or bilateral.

- Check if the nipple is red, sore, presence of a rash or swelling.

- Check for dimpling of the skin (called peau d’orange and is like orange peel because of an inflamed tumor under the skin). Peau d’orange appearance is of serious significance.



Palpation

Different people have different techniques and, whilst the following is recommended here, it is by no means the only acceptable technique.



 - Lie supine and feel your breasts, using your right hand to feel your left breast and your left arm to feel your right breast. Examine with the flat of the hand to avoid pinching up tissue. Use a firm, smooth touch with the second, third and forth fingers, keeping the fingers flat and together. Feel your breasts in a circular motion, beginning with light pressure and then repeat the same area using medium and deep pressure before moving to the next area.



- Cover the entire breast from top to bottom, side to side, from your collarbone to the top of your abdomen, and from your armpit to your cleavage. 

- Raise your arms and check for any lumps or thickening in your underarm area, do this on both sides.

- Look for any sign of fluid coming out of one or both nipples.

- Finally, feel your breasts while you are standing or sitting. Many women feel that the easiest way to feel their breast is when their skin is wet and slippery, so they like to do this step in the shower.

Any unusual observation should be reported to your doctor.

In breast cancer, most patients present having felt a lump (20% as a painful lump), 10% of patients present with nipple change, 3% present with nipple discharge, 5% present with skin contour changes. Breast pain/mastalgia alone is a very uncommon presentation.

Risks of breast cancer:

1. Previous history of breast cancer

2. Family history of breast cancer in first degree relative. The BRCA1, BRCA2, TP53 mutations carry very high risk but only 3 to 5 of women are likely to carry them on their chromosome.

3. Risk increases with age; less than 5% of cases present before 35years, less than 25% before 50years

4. Never having borne a child, or first child after 30

5. Not having breastfed(breast feeding is protective)

6. Early menarche (beginning period before age 12) and late menopause (after age 55)

7. High alcohol intake may increase risk in a dose-related manner.

8. Other risk factors include being overweight, using hormone replacement therapy, taking birth control pills.

References

American Cancer Society (2005). ”Breast Cancer Facts & Figures 2005–2006” (PDF). Archived from the original on 13 June 2007. Retrieved 2007-04-26

eMedicine (23 August, 2006). ”Breast Cancer Evaluation”. Retrieved 2008-02-05.

Chalasani P, Downey L, Stopeck AT. Caring for the breast cancer survivor: a guide for primary care physicians. Am J Med. 2010;123(6):489-95.

Chlebowski RT, Anderson GL, Gass M, et al. Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA. 2010;304(15):1684-92.

. . . . . .

Learn more about this author, Victory Oyaletor.
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