Why should one do BSE? There is a 1 in 10 chance that a woman will have breast
cancer during her lifetime. Over 1,000,000 women find lumps in
their breasts every year some of which are cancerous but most are
benign. A simple Breast Self-Examination (BSE) can be the key to
finding any abnormality early.
Statistics about breast cancer
* Approximately 25% of breast cancers will result in death.
* Breast cancer is the second most common cancer found in women
(following uterus cancer).
* If diagnosed and treated early, almost 95% of all breast cancers
can be cured. That's why the BSE is so important.
Risk factors
There are several risk factors that will determine how likely you
are to have breast cancer:
Age: It is rare for women younger than 35 to have breast cancer.
The risk increases with age. Most breast cancers occur in women
older than 50 years.
Family history: If your mother, sister, or daughter has developed
breast cancer before menopause, you are three times more likely to
develop the disease.
Personal history: If you've had breast cancer, you have an
increased risk of getting it again. Also, if you've had benign
breast disease (e.g., fibrocystic breast disease), you are at an
increased risk.
The following also put you at greater
risk:
* If you began menstruating early (before age 12)
* If you take birth control pills (though evidence is not
conclusive)
* If you never have children
* If you have not breast-fed your children
* If you have children when you are 30 or older
* If you have menopause at 55 or later
* If you take Hormone Replacement Therapy (HRT).
Most of these risk factors involve your level of oestrogen. Higher
oestrogen levels are strongly linked with susceptibility to breast
cancer.
Lifestyle: There is a lower incidence of breast cancer among women
who exercise regularly and a higher proportion of breast cancer
among obese women. There is also evidence that there is increased
risk of breast cancer with increased alcohol use (i.e., 3 or more
drinks per week).
Who should do BSE?
It is good to be in the habit of breast self-examination (BSE) on
a regular basis since early detection leads to early investigation
and treatment. Women of all ages should perform self-examination
since breast problems can occur at any age. The best time of the
month to perform self-examination is after menstruation, when the
breast tissue is softer and lumps are more likely to be felt.
Immediately prior to menstruation the breast becomes naturally
lumpy and often tender - features that can mask a problem. For
women who are post-menstrual, with irregular periods or who have
had hysterectomy, a suitable time should be chosen - for example
the 1st day of the month. Examination more frequently than this,
is probably not necessary and may lead to increased anxiety. A
woman who regularly examines her breasts will get a very clear
idea of her normal breast texture and consistency, and will help
her to notice if something is different. Individual hospitals and
specialists may advise slightly different methods, but the
principles of BSE are the same.
How to do BSE?
There are two basic steps to conducting a BSE:
1. Visual Examination
2. Tactile Examination
Visual Examination
During the first part of the BSE, the visual examination, you look
for changes in each breast. What is important in visual BSE is not
the normal difference between your two breasts, but any change in
one breast without a similar change in the other. The changes you
have to look for include:
* Shape
* Size
* Contour or symmetry (is there a difference in the level between
your nipples? Do both breasts look symmetrical?)
* Skin discoloration or dimpling
* Bumps/lumps – NOTE: normal lumpiness, like in the week before
and of your menstrual cycle, will appear as very small and
separate lumps like the texture of an orange.
* Sores or scaly skin
* Discharge or puckering of the nipple
* Dimple
* Ulceration
Stand in front of a mirror and look for the above changes in your
breasts (from both a frontal and profile view) in 3 different
positions:
1. With your arms raised
2. With your arms down at your sides
3. Bending forward
* with your hands on your hips and shoulders turned in
* with your arms relaxed hanging in front of you
Tactile Examination
This is the part of the examination when you need to feel your
breasts for any changes. It is important to check the surrounding
areas because breast cancer may be found in the lymph node tissue
around the breast and underarm. Begin by lying in bed. Place a
small pillow or folded towel under your left shoulder and your
left hand behind your head. Your shoulder should be raised high
enough for your left breast to be center on top of your chest,
falling neither to the center nor toward the armpit; this
arrangement distributes the breast tissue as evenly as possible
across the chest wall. If a breast is not properly flattened
against the chest, it is difficult to feel a lump – particularly
in the outer upper quadrant, where tissue is thickest (and where
most cancers occur).Feel your breasts and surrounding areas, which
include:
* the breast
* between the breast and underarm
* the underarm
* the area above the breast up to the collarbone and across to
your shoulder
Use the pads (where your fingerprints are) of your three middle
fingers on your right hand pressed together flat to check your
left breast, and do the opposite for the right breast. You should
press on your breast with varying degrees of pressure:
* light (move the skin without moving the tissue underneath)
* medium (midway into the tissue)
* hard (down to the ribs "on the verge of pain")
When using any of the 3 patterns, you should always be using a
circular rubbing motion without lifting your fingers.
Patterns of breast examination
Spiral: Begin with a large circle around the perimeter of your
breast and make smaller and smaller circles as you work your way
toward the nipple.
Wedges: Pretend your breast is divided into sections like
triangular pieces of a cake, begin in the nipple area and feel
your breast in a small circular motion within one section, then
move on to the next wedge starting in the nipple area again.
Vertical or linear: Pretend your breast is divided into vertical
stripes. Begin on the underarm area on one side and feel your
breast in a small circular motion up and down in a zig zag pattern
till the whole breast is covered. Then repeat the process for the
right breast with your left hand.
What to feel for?
Carefully notice the "feel" of your normal breast structure, so
that you can note at once any changes from what is usual for you.
Many women have a normal thickening or ridge of firm tissue under
the lower curve of the breast, at its attachment to the chest
wall; also the large milk ducts can be felt as a ring of bumps at
the outer edge of the areola. In very slender women, the bony
prominences of the chest wall may be mistaken for chest tumours,
as may enlarged milk glands, fat tumours, lymph nodes, or benign
cysts. All such thickenings should be felt carefully during each
monthly BSE, in order to distinguish normal conditions from
potentially dangerous changes. Any lump or other change found in
one breast only (especially in the upper outer quadrant) is more
likely to be serious. If in doubt about ANY development, consult
your doctor.
In the shower
Many lumps are more easily felt when the breast and fingers are
wet and slippery with soap lather, which reduces the friction. If
your breasts are small, place one hand on your head and examine
the breast on the side with your opposite had in an up-and-down
pattern, as you do lying in bed. If your breasts are large or
pendulous, you will be better able to feel them if you immobilize
a breast with one hand (first supporting from below, then pressing
down from above) and examine it with the other hand (first from
above, and then from below).
If you find that you exhibit any of the characteristics as
described above, do not delay. Go see your physician immediately
for a clinical breast examination and other tests for a definite
diagnosis.
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