Breast-related ailments are more commonly seen in women than in men. Opposed to common belief, breast ailments can occur at any time during a person's lifetime. It is thus essential for men and women to understand the normal development and ageing process of the breast. Being aware of normal changes that occur in the breast at different development stages can help you identify unusual developments in your breast. Most changes that occur are due to benign conditions and can be detected through regular Breast Self-Examination (BSE). This also helps in early detection and treatment of Breast Cancer.
Breasts, technically known as mammary glands, are glandular organs that produce milk in response to hormonal changes that occur during childbirth. Breasts are made up of two main types of tissues:
1. Glandular Tissues: The glandular part of the breast has 15-20 lobes with a number of lobules and ducts surrounded by fatty and supportive tissue. The lobes are connected to the nipple by ducts to produce and deliver milk.
2. Supporting Tissues: The supporting tissue of the breast includes fatty tissue and fibrous connective tissue that gives the breast its size and shape. In each armpit there are about 20–30 lymph nodes (glands) that drain fluid from the breast. These are a part of the lymphatic system that helps the body fight infection.
It is common and perfectly normal for one breast to be larger than the other. The nipples usually point forward, although they may look different on each breast. It is not unusual for one or both nipples to be turned inwards (inverted). This can be present from birth or can occur during the development of the breasts. The nipples themselves are hairless, but some women have a few hairs around the areola (the colored skin surrounding the nipple).
Between 0.4 and 6% women have an extra breast or pair of breasts, although these tissues may not look like a breast, they can be misdiagnosed as lymphatic or cystic. These are usually found in the lower armpit and are known as accessory breasts. Some women can even have extra nipples. These are usually below the breast or above the belly button on an imaginary line between the normal nipples and the groins. Accessory breasts and extra nipples aren't something to worry about and don't need to be removed.
Breast development and ageing
Changes during the development of breast happen as early as puberty and they constantly change through adolescence, childbirth and menopause. These developments are mainly affected by variations in the levels of estrogen (the female hormone that is responsible for typical female sexual characteristics) in the body. Here are some natural developments one can notice:
- A girl's breasts start developing around the age of 9-11, although breast development may start earlier or later depending on the body type
- Once a girl starts menstruating, small changes develop in the breast just before the menstrual cycle starts. The breasts may become larger, tender or feel slightly lumpy. However, after the menstrual cycle these changes fade away and the breasts return to their normal state. Some women also experience breast pain during their menstrual cycles
- The most significant developments in the breasts happen during pregnancy, as a preparation for breastfeeding. During the first stages of pregnancy the breasts become tender and sensitive. As a result of an increase in the milk-producing cells; the breasts along with the areola become larger. The blood vessels become more visible and the nipples become darker.
- Once breastfeeding starts the breasts change size several times during the day. This is due to large amounts of milk that is produced. After breastfeeding the breasts return to their normal shape and size, although there might be a variation in size and a decrease in firmness.
- Menopause is the last stage of change in the breasts. As menopause approaches, breasts lose tissue and fat and become smaller and lumpy.
There are numerous breast ailments that can occur during various stages of one's life. Breast ailments thus can be categorized under these four age groups:
- Breast concerns in infancy and childhood: Pediatric breast problems are noticed in infancy and later during childhood as well. Most common concerns are:
- Nipple discharge: Noticed in both male and female infants, can occur in one or both nipples. The discharge may be clear or milky and is not a cause for concern as it is usually caused by stimulation of an infant's breast tissues by maternal hormones during pregnancy.
- Swelling: Swelling can occur in one or both breasts and is caused by an enlarged breast bud just below the nipple. This swelling could persist for several weeks or months.
- Redness and swelling around the nipple: This again is a non-threatening condition and is resolved naturally.
- Extra breast tissue (polymastia) or Extra nipple tissue (polythelia): Polymastia and polythelia is the occurrence of an extra breast or extra nipple. The extra tissue in both cases causes no physical problems but can be removed with surgery if it causes emotional or psychological problems.
- Premature breast development: This condition is noticed in young girls and is the presence of a non-tender swelling beneath the nipple area. Other signs of early puberty like pubic and axillary hair, menstruation, and other effects caused by estrogen stimulation are absent.
- Breast concerns in adolescents Breast disorders in this age group are mostly benign but can be a cause of increased anxiety for the patient and the family. A good understanding of common concerns and normal developments during this age will help avoid unnecessary worry. It is also good practice to educate adolescent girls about pubertal changes, normal anatomic variations and the potential risks of invasive cosmetic styling such as piercings, etc. Benign diseases that dominate breast concerns in this age group include:
- Breast development problems: These include early or delayed breast development, unusually large or small breasts or even asymmetric breasts.
- Breast pain: Breast pain among girls in this age group is cyclic and usually worsens on days before the menstrual cycle.
- Nipple discharge: There is a white, clear, red, yellow or brown discharge from the breast in such cases and is mostly benign. This condition is caused due to chronic local irritation.
- Breast lumps: This condition is benign and should not be a cause for worry.
- Cosmetic concerns: This age group sees a rise in cosmetic concerns like breast augmentation and piercing. These conditions are potentially risky and thus the guidance of an expert is encouraged in these cases.
- Breast concerns in middle-aged women: Breast lesions are a common concern among women in this age group. Benign lesions frequently occur in women but malignant lesions whenever noticed are a cause of concern as breast cancer is a common malignancy in women. Common concerns in this age group are:
- Benign breast diseases: These include conditions like fibrocystic changes, cysts, fibrodenomas, intraductal papilloma, traumatic fat necrosis.
- Breast concerns in pregnant women: During pregnancy a woman's breast undergoes certain changes and concerns like sensitive and tender breasts, nipple discharge and inverted nipples are commonly noticed.
- Breast concerns in lactating women: The lactation period also causes the breasts to undergo various changes like sore nipples, enlarged breasts, breast abscess and plugged ducts.
- Malignant breast diseases: Breast cancer is one of the relatively common cancers and it accounts for 30% of all cancers among women. Breast cancer is rarely seen in women under the age of 25 and the risk of developing breast cancer steadily increases with age.
- Cosmetic concerns: Following breastfeeding, the breasts start sagging and this leads to cosmetic concerns like re-shaping and re-sizing of the breast. Women who undergo mastectomy also consider breast reconstruction.
- Breast concerns after menopause: Menopause is the end of the menstrual periods and is caused because the ovaries stop responding to the controlling hormones released by the pituitary gland in the brain. The ovaries thus fail to release an egg each month and the production of the female sex hormones, estrogen and progesterone stops. These changes in the body lead to loss of tissue and fat in the breast. The breast also tends to become smaller and lumpy. These changes being benign do not lead to cancer but can develop into breast cysts (benign fluid-filled sacs). However, breast cancer is a main concern in this age group. Another factor that increases the risk of development of breast cancer in post-menopausal women is the hormone replacement therapy commonly followed by women in this age group.
Common Breast Concerns
Breast pain is very common and rarely indicates cancer. It is more prevalent in younger women or older women who use hormone replacements. It can be mild or severe enough to impact one's daily activities.
Breast pain can be cyclic or non-cyclic. Changes in cyclic pain are experienced during the menstrual cycle. It starts as a dull aching pain in both breasts before the menstrual cycle. Once the period starts the pain reduces and the breasts feel lumpy and may be swollen. It affects young, menstruating women.
Non-cyclic pain is more constant and does not vary, although it can come and go. It is usually a tight, burning pain or soreness and mostly occurs in one breast although it may occur in both. This type of pain is more common in women after menopause.
Occasionally, pain might be felt in the breast but is actually caused by other conditions like a pulled muscle in the chest wall or rib cage. This pain usually affects one side of the breast and worsens when you take a deep breath. You should consult a doctor if the pain worsens over time or if the pain persists daily for more than 2-3 weeks or interferes with your life.
What causes breast pain?
Main factors attributed to breast pain are:
- Hormone changes
- Hormonal birth control methods
- Hormone replacement therapy
- Fertility drugs
- SSRI antidepressants such as Zoloft or Prozac
- Caffeine: as it can worsen breast pain
- Fatty acid imbalance in cells
- Large breasts: They may contribute to non-cyclic pain and also cause back and shoulder pain.
- Breast cysts and trauma
Most breast lumps are non-cancerous. Some women have lumpy breast tissue while others have cysts or benign tumors. Any persistent lump or change in the breast tissue should be checked with a doctor. Most breast cancers occur in women over the age of 50.
What are Fibrocystic Breast changes?
Fibrocystic breast change is a common, benign (non-cancerous) condition that results in painful, lumpy breasts. Usually both breasts are affected although one may undergo more changes than the other. Breast cysts (fluid-filled sacs) and solid lumps (fibroadenomas) may be felt in affected breasts. Fibrocystic changes rarely bother women after menopause and the exact cause is unknown. Presence of fibrocystic breast tissue does not increase risk of breast cancer.
What are breast cysts?
Cysts are fluid-filled sacs in the breast tissue. They may be larger before the menstrual period and less noticeable afterwards. They usually feel soft and tender. Fibrocystic breast tissue may have many cysts. This does not increase risk of developing breast cancer.
What is a fibroadenoma?
A fibroadenoma is a benign (non-cancerous) breast lump. They feel firm and rubbery and are well-defined. They are common in young women between the ages of 20-30. They can be small or large and move easily. They are not painful and the size does not fluctuate with the menstrual cycle.
What is Breast Cancer?
Breast Cancer is a disease in which certain breast tissue cells undergo uncontrolled abnormal growth and form a malignant tumor. A malignant tumor is a group of cancer cells that grow and invade the surrounding tissue or spread to distant areas of the body.
Breast Cancer commonly develops in cells in the inner lining of the milk ducts or the lobules that supply the ducts with milk. Other forms of Breast Cancer form in the glands that produce milk (lobular cancer) or in other parts of the breast.
How does Breast Cancer Occur?
Breast Cancer is caused by mutations or abnormal changes that occur in the genes responsible for the growth of cells and also for keeping them healthy. These genes are present in the nucleus of a cell and are known to be the "control room" of every cell.
Our body usually follows a healthy process of cell growth that involves healthy cells replacing old ones as they burn out. However, over a period of time, mutation causes certain genes to be active and deactivates certain other genes in a cell. This changed cell then divides without following an order and in the process produces many more cells just like it. This forms a tumor.
What is the incidence of Breast Cancer?
Cervical cancers top the list of most common cancers affecting Indian women, with breast cancer rapidly competing for the top position. As per a survey conducted by ICMR (Indian Council of Medical Research), for every 22 women there is one woman who is affected by breast cancer in India as compared to the one in eight women reported in the US. This indicates that breast cancer affects a lesser number of women in India in comparison to women in western countries. However, the incidence varies between urban and rural women. In Mumbai, about 27 new cases per 100,000 women per year were found, while in rural Maharashtra it is only eight per 100,000 women.
What are the causes of Breast Cancers?
- Positive family history of breast cancer- If a woman's mother has breast cancer, her risk increases by about 3%. If she has a sister, the risk increases by 2-3%.
- Hereditary- most cases of breast cancer are not inherited and only 5 % of breast cancers are hereditary
- Early menarche and late menopause
- Late child birth- after 30 years of age
- Increase in body fat
- Prolonged use of OC pills
- Women on HRT (hormone replacement therapy) for more than 10 years
- Oncogenes- Related to BRCA1 and BRCA2 genes
How is Risk Assessment for Breast Cancer performed?
Risk assessment is performed using a Breast Cancer Risk Assessment Tool developed by the National Cancer Institute and National Surgical Adjuvant Breast and Bowel project (NSABP). The tool allows a health professional to project a woman's individual estimate of breast cancer risk over a five year period of time and over her lifetime. He/she then compares the woman's risk calculation with the average risk for a woman of the same age. There are some risk factors included in the tool.
- Breast abnormalities: Ductal and Lobular carcinoma in situ is associated with increased risk of development of invasive breast cancers
- Age: Women over 50 years of age are at an increased risk.
- Age at menarche: Women who start menstruation early (before 12 years of age) are at an increased risk of developing breast cancers.
- Age at first child birth: Risk depends on the woman's age at first child birth and family history of breast cancer. For women with 0 or 1 affected relatives, the risk increases with age at first child birth. For women with 2 or more first degree relatives, risks decrease with age at first child birth.
- Patients with first degree relatives suffering from breast cancer: are at an increased risk of developing breast cancers.
- Breast biopsies: Patients who have undergone breast biopsy and in particular if the biopsy has shown a change in breast tissue (atypical hyperplasia) are at increased risk.
- Race: The risk of developing breast cancer is high in white women than black although more number of deaths is reported in black women due to breast cancer.
Most Common Types of Breast Cancer:
Ductal carcinoma in Situ (DCIS)
Ductal carcinoma accounts for 85-90% of all cancers. This is a condition in which there is growth of ductal cells inside the milk ducts of the breast. "In situ" (Stage 0) means that the abnormal cells are refrained/controlled in one place and do not metastasize. DCIS does not progress to invasive cancers mostly. Usually there are no signs and symptoms except a small lump which causes nipple discharge and this is what brings the patient to the surgeon. Diagnostic Mammogram shows deposits of calcium (micro calcifications). DCIS can be diagnosed also by Fine needle aspiration biopsy, core needle biopsy, and open surgical biopsy. The treatment modality consists of Lumpectomy, Radiation, and Hormone therapy for women for hormone-therapy receptor positive DCIS.
Lobular carcinoma in situ:
Lobular carcinoma accounts for about 8% of all reported cases of cancer. This is a condition in which the lobule where the milk accumulates in the breasts is filled with atypical cells which are localized (so referred to as in situ). Although being a precancerous condition, this does not lead to breast cancer but women with LCIS are at a greater average risk of developing breast cancers at some point in their life. There are no signs and symptoms of breast cancer in this condition; breast biopsy is the only means of diagnosing the disease. Treatment consists of lumpectomy and patients are thereafter advised to have regular mammograms (once every year/two) and clinical breast examinations (once/twice in a year)
HER2–positive breast cancer
HER2-positive breast cancer is caused by a gene called HER2. This cell encourages cells to divide, grow and also repair themselves. When cells have many copies of this gene, they along with the cancer cells multiply and grow faster. This particular type of cancer caused by the HER2 gene is more aggressive than other forms of breast cancer.
Inflammatory breast cancer
This cancer starts in the milk ducts and spreads to the skin and lymph systems. This condition is accompanied by pain and skin changes. It can be diagnosed by a mammogram and an ultra-sonogram.
Invasive/Infiltrative breast cancer
Here the cancer cells which are present in milk ducts/lobes spread to and invade healthy surrounding tissues. Invasive cancer metastasizes through lymphatic and blood streams.
Invasive Ductal Carcinoma (IDC)
The most common types of breast cancers (IDC) which invades the breast tissues in the milk ducts are:
- Medullary Carcinoma- Prognosis is good.
- Metaplastic Breast Cancer- Rare form of breast cancer which is treated aggressively with uncertain prognosis.
- Paget's disease of Nipple- Indicates the presence of breast cancer beneath the skin.
- Tubular Carcinoma- Appears like tubular glands on microscopy and amongst all cancers has better prognosis.
- Invasive Lobular Carcinoma- Starts in the milk producing glands and lobes and then becomes invasive.
- Papillary Carcinoma-This is a type of DCIS which is rarely invasive and stays within the milk ducts.
The not-so-common Invasive Breast Cancer Types are:
- Adenoid cystic carcinoma
- Mixed tumors
- Mucinous carcinoma
- Sarcoma of the breast
- Phyllodes tumor
Various treatments are available for patients suffering from breast cancer. While some of these treatments are standard, some are still being tested via clinical trials.
Staging Breast Cancers:
What is staging?
Staging indicates the severity of a person's cancer. This is decided based on the extent of the primary tumor and the extent to which cancer has spread to other parts of the body.
Staging is important because it helps the doctor decide the appropriate treatment and the stage helps in estimating the person's prognosis.
Staging systems are based on the knowledge of how cancer progresses. Cancer cells multiply without control or order and do not die when they should; resulting in a tumor. As the tumor grows, it can invade the surrounding tissues and organs.
Cancer cells can also break away from the tumor and enter the bloodstream or the lymphatic system, spreading from the primary site to lymph nodes or other organs, where they may form new tumors. The spread of cancer is called metastasis.
Usually the TNM system of staging is followed.
The TNM system is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of distant metastasis (M). A number is added to each letter to indicate the size or extent of the primary tumor and the extent to which the cancer has spread.
The international TNM classification recognized for staging is:
- T: Extent of primary tumor.
- T1 to T3 shows the increase in the extent or size of the tumor.
- N: Involvement of lymph nodes.
- N1 to N3 shows the increasing node involvement.
- M: Presence of metastases (distant spread).
- M0 indicates no metastases.
- M1 indicates presence of metastases.
What are the symptoms of Breast cancers?
Usually DCIS and LCIS are seen without a lump or with the presence of just one lump but generally the symptoms are:
- A painless lump in the breast
- Dimpling of the skin in the area of the lump appearing like orange peel- "peau de orange" appearance
- A blood stained nipple discharge
- Pain in the breast
- Inversion of the nipple
- Presence of a patch of dry flaky skin on the nipple and change in appearance or texture of the breasts– Usually seen in Paget's disease
- General Symptoms- fever, loss of appetite, fatigue
What are the methods/investigations of Diagnosing Breast cancers?
- Mammography is the gold standard investigation used for early detection and diagnosis of Breast cancers. It uses a special type of low dose x-ray system to diagnose. It is performed regularly at a two year interval in the West but in India it is advisable to do it every year. There are two variants of mammography: Digital mammography and Computer-aided detection (which searches for areas of density, calcification and mass).
- Screening Mammography is used for early detection of breast cancers as it shows abnormal changes in the breast during the initial two months. It is used to diagnose DCIS. According to WHO, mammography helps reduce mortality resulting from breast cancer by 15-25% in the 50-69 age group.
- Diagnostic Mammography is used to evaluate breast lump and is performed after screening mammography.
There is a slight risk of exposure to radiation in Mammography. Mammography is advised for Indian women in the age group of 40- 50 years and is compulsory for women above 50 years. Patient compliance is low as it is costly, technology driven and requires stringent quality control and experienced technicians and doctors.
- Self-examination of the breast- A woman should self-examine her breasts once a month after a visit to the doctor. Self-examination procedures can be learnt from the Doctor.
- Breast Examination- To be done by the consulting doctor.
- CT Scan
- Lymph Angiogram
- Fine Needle Aspiration Cytology
- Estrogen Sensitivity
- Biochemical Screening
- Estrogen and Progesterone receptor test
What are the standard treatments for Breast Cancer?
- Surgery: Usually Breast conversion surgery is conducted with the aim of removing the cancer but not the breast.
- Lumpectomy- Removal of a lump including a part of the normal tissue surrounding it.
- Partial Mastectomy/Segmental Mastectomy- Removal of a part of the breast which has cancer and normal tissue surrounding it.
- Total Mastectomy- In this procedure, the whole breast which has cancer is removed. Also, some lymph nodes are removed under the arm for biopsy (lymph node dissection).
- Modified Radical Mastectomy- The entire breast with the cancer is removed with lymph nodes from the lining over the muscles on the chest and under the arm. In some cases a portion of the chest wall muscles are also removed.
- Radical Mastectomy- It is also known as Halsted Radical Mastectomy. The entire breast affected by cancer is removed, chest wall muscles under the breast and all of the lymph nodes under the arm are also removed.
- Radiation Therapy: It utilizes high energy x-rays or other types of radiation to kill cancer cells. Two types of radiation therapy are used: External and Internal therapy depending on the type and stage of cancer. External therapy uses a machine outside the body to kill cancer cells by radiation. Internal therapy makes use of a radioactive substance that is concealed in seeds, needles, catheters or wires and is positioned directly into or near the cancer.
- Chemotherapy: A cancer treatment in which drugs are administered orally or intravenously to stop the growth of the cells and to kill the neoplastic cells.
- Hormone Therapy: This treatment eliminates hormones or blocks their action and hinders the growth of cancer cells. Patients, who suffer from early stages of breast cancers and those suffering from metastatic breast cancer, are given hormone therapy with tamoxifen. Instead of tamoxifen, aromatase also can be given. The drawback is when tamoxifen is given with estrogen; risk of development of endometrial cancer is high. So women who take tamoxifen are advised to undergo pelvic examination every year to check for endometrial cancer and to look out for vaginal bleeding. If a patient (postmenopausal) has hormone dependent breast cancer, hormone therapy with aromatase is the treatment of choice.
- Targeted Therapy: In this form of treatment, drugs or other substances are used to identify and attack special cells without harming the normal cells. There are two types of targeted therapies which are under study for treatment of breast cancer:
- Monoclonal antibodies used are Trastuzumab (Herceptin), which blocks the effects of the growth factor protein HER2 which causes growth of neoplastic cells.
- Lapatinib: This is a tyrosine kinase inhibitor that is used to block the effect of the HER2 protein. Patients with HER2 positive breast cancer that has progressed following treatment with Trastuzumab benefit from Lapatinib.
- Sentinel Lymph Node Biopsy followed by Surgery: Sentinel lymph node is the first lymph node to receive lymphatic drainage from the tumor and it is the first lymph node the cancer is likely to spread to from the tumor. So, a biopsy of this lymph node is done and if no tumor is found, removal of the lymph nodes is not necessary. After a sentinel lymph node biopsy, the surgeon will proceed to breast conserving surgery/mastectomy.
- High-Dose Chemotherapy with Stem Cell Transplant: This type of treatment involves high doses of chemotherapy and replacing blood forming cells which are destroyed by cancer treatment. Research has shown that stem cell transplant that follows high-dose chemotherapy is not more effective than standard chemotherapy for treating breast cancer.
How can Breast cancer be prevented?
Breast Cancer can be prevented by regular self-examination of both breasts for lumps and other symptoms such as change in size, inverted nipple, rashes, and swelling. If there is a positive family history of breast cancer, a regular mammography should be conducted after 30 years of age.
What are the complementary therapies which can help in the healing process?
- Relaxation exercise
- Psychological counseling
- Support of family and colleagues
Is increased breast size a risk factor for Breast cancer?
Studies have shown that women with larger breasts are at a greater risk of developing Breast Cancer before menopause than women with smaller breasts. Cancers develop on the outer rim of the breast due to more tissue mass.
If either of the parent's side has it does the risk of breast cancer increase?
If anyone from the paternal side has breast cancer, there is little or no chance of developing breast cancer. The risk doubles if a first degree relative (mother or sister) suffers from it. If more than two first degree members suffer from breast cancer, the risk increases by 50%.
Do birth control pills cause Breast cancers?
Studies have indicated that girls under the age of 18 who regularly use this method of contraception have a 30-40 % risk of developing Breast Cancer (Reported more in western countries).
There is also evidence that HRT used by post-menopausal women increases the risk (63%) of development of breast cancer.
Does wearing an under-wired bra increase the risk of breast cancer?
It does not cause breast cancer but women who wear ill-fitting bras may develop fat necrosis.
Is Breast cancer preventable?
Breast Cancer can be prevented if you:
- Have your first child between the age of 20-25 years and the second child before 28 years of age.
- Breastfeed for a year after giving birth and maintain a healthy diet.
- Abstain from alcohol.
Does getting an annual mammogram increase the risk of cancer?
Annual mammograms do expose a patient to radiation but to a negligible amount. However, doctors recommend getting routine physical check-ups done once every two years after the age of 50 as a precautionary measure.
Do only women suffer from breast cancers?
No, men suffer from breast cancers too. Research has shown that for every 100 women suffering from breast cancer, one male is diagnosed too.
What is the latest development in Breast cancer treatment?
- Some drugs used by cancer patients are being developed for the prevention of breast cancer.
- Oncoplasty is a procedure used to reconstruct the breast after mastectomy using the patient's healthy breast tissue.
- Trastuzumab is a drug in the pipeline for reducing the risk of recurrence.
How is Breast Reconstruction Surgery done?
In cases where a patient has to undergo a mastectomy, breast reconstruction may be considered. Breast reconstruction can be opted for at the time of the mastectomy or in the future. Reconstruction of the breast can be done in two ways. One method is to use the patient's non-breast tissue to rebuild the breast. The second method involves the use of implants that are filled with silicone gel or saline.
Advices/ Key points:
- Breast cancer is one of the leading causes of cancer-related deaths across the globe and importantly is one of the only few cancers which can be picked up early if timely check-ups are done including clinical breast examination and mammograms.
- The whole purpose of 'Breast Health Awareness' is to detect any abnormal lesion in the breast early so that breast cancer can be detected at an early stage and is still in the purview of 'cure'.
- In India almost one in 22 women are diagnosed with Breast Cancer and most of them are stage III & IV unlike the West where Stage I & II are most commonly reported. Most cases in India are reported or diagnosed late either due to lack of awareness or because women are too shy to come to a doctor to voice their problems.
- We can help bring down cancer-related deaths and increase survival by increasing awareness among family and friends, regular screening and incorporating improved treatment methods.
Breast Self-Exam (BSE)
BSE is good practice for women starting their 30's. If you practice BSE on a regular basis, you will be aware of how your breasts normally feel.
When to do BSE?
Women over 30 years of age should follow BSE regularly. BSE should be performed about one week after the beginning of each menstrual cycle. After menopause, it should be done at the beginning of each month.
How is Breast Self-Examination (BSE) done?
- While standing in front of a mirror, observe each breast individually. Notice the shape, size, contour, color, and orientation of your breasts and nipples.
- Look for signs of swelling, dimpling, redness or soreness in all parts of your breasts.
- Start BSE from just below the collar bone. If you are examining your right breast use your left hand.
- Apply body lotion on the pads of your fingertips. While using a fair amount of pressure trace small circles as you move your fingertips up and down, back and forth. Follow a pattern that will help you cover the entire breast including the nipple.
- Continue examining till you cover the breast tissue in the underarm.
- Switch hands and repeat BSE on the other breast.