Self-examination of Breast Cancer Disorder- All you need to know

Dr. Aruna Muralidhar MD, MRCOG, FRCOG (UK), Associate Director and Senior Consultant Obstetrician and Gynaecologist, Fortis La Femme, Bangalore

Cancer-the emperor of maladies, is unfortunately increasing in incidence. The causes are multifactorial. In women, breast cancer has become the most common cancer. It is estimated that worldwide over 5,08,000 women died in 2011 due to breast cancer (Global Health Estimates, WHO 2013). Although breast cancer is thought to be a disease of the developed world, almost 50% of breast cancer cases and 58% of deaths occur in less developed countries (GLOBOCAN 2008). The age distribution of breast cancer also is changing and younger women are also developing breast cancer.

The good news however, is that breast cancer is amenable to early detection since it involves a superficial organ which is not hidden deeply in the body. The symptoms and signs are also easily detectable by oneself.

Self-breast examination (SBE) is the most important basic level of detection of breast cancer. SBE is a convenient, no-cost tool that anyone can use on a regular basis and at any age. Self-breast examination is ideally done by oneself after the periods in front of the mirror in your bathroom while having a shower. It will become easier the more often it is done. It would be ideal to examine oneself after the periods as they are less likely to be swollen and tender. In postmenopausal women, a particular date on the calendar can be fixed for SBE.

The steps of SBE are as follows:

  1. Look in the mirror with the hands over the hips for symmetry, skin changes, lumps, changes in the black area around the nipples (areolae) and nipples
  2. Raise the arms and look for the above
  3. Feel breasts with the pulp of the fingers of the opposite hand
  4. The entire extent of the breasts has to be examined from the arm pit area towards the breast and inwards till the midline on both sides. Feeling the breast tissue with the pulp of the fingers would give the best feel and one would be able to distinguish the different areas of the breast.
  5. Either feel in a circular fashion or up and down in a linear fashion
  6. Feel the entire depth from the front to the back of the breasts i.e., the skin to the rib cage with differing pressures
  7. Finally, feel the breasts whilst lying down in the same manner as above

What is a lump is detected?

If a lump detected, it is important not to panic as lumpiness or even lumps are mostly benign and may be due to the hormonal changes that occur during the menstrual cycle. The lumpiness and sometimes pain or soreness is more pronounced in the second half of the cycle due to the hormone progesterone. Lumps in the breast may be non-cancerous like fibroadenoma (also called breast mouse), fibrocystic disease, fibroadenosis, sebaceous cysts, lipomas, injury etc.

However, one should not hesitate consulting a gynaecologist or a breast specialist/surgeon, if the following are noted

  • The lump has lasted more than one menstrual cycle
  • Growing bigger
  • Lump feels hard and irregular
  • There are skin changes over the lump
  • It is associated with discharge from the nipple especially if bloody
  • Associated with lumps in the armpit
  • Nipple seems pulled inwards

Whom to consult and what to expect?

If any of the above are found, it is recommended to see a gynaecologist especially who are specialised in breast diseases management or a breast specialist. Ideally, the appointment needs to be fixed after a period. A detailed history is obtained including menstrual cycles and breast changes, family history of cancers, medication use etc. A clinical breast examination is then done and a mapping of the breast is documented. An ultrasound of the breasts is usually requested for a detailed evaluation of the breast tissue. Most of the times, the lumps are benign and may just need a follow up at regular intervals. In some conditions, medications may be prescribed. Surgery may be advised even in benign lumps especially if they are large.

If the lady is more than 40 years of age or if there is any strong suspicion of cancer in a younger lady, a mammogram may be requested which involves a procedure in the X ray room in a special machine. Further tests may be required in some cases such as MRI breasts or fine needle aspiration biopsy (FNAC).

Self-breast examination is a very useful tool for early detection of breast problems and all women must use this tool on regular basis as early detection saves lives.