Are you checking your breasts correctly? A doctor’s guide
Most breast lumps are harmless. But if they’re cancerous, then the earlier they are treated the better — so, make sure you’re checking your breasts regularly
How often do you check your breasts? If it’s rarely or never, then you might be inadvertently putting your health at risk. Breast cancer is the most common cancer in women worldwide, representing 25.4% of all cancers in women. It’s also one of the most treatable and the earlier it is picked up, the better the outcome.
‘The earlier breast cancer is detected and treated, the better the prognosis,’ says Dr Elisabeth Rosen, medical doctor at Livi. ‘That’s why it’s important to get into the habit of checking your breasts regularly.’
When is the best time to check my breasts?
‘Knowing how your breasts should look and feel normally can help to alert you to any unusual changes that may be a symptom of breast cancer,’ says Dr Rosen. ‘Ideally, you should check your breasts once a month on the same day, a few days after your period.’
Like the rest of your body, your breasts react to hormonal changes during your menstrual cycle. Many women, for example, find their breasts naturally become swollen, tender and even lumpy in the week or so leading up to their period, so that’s not an optimal time to check them.
If you’re postmenopausal, do a self-check on the same day every month.
Am I eligible for screening?
The risk of breast cancer increases with age and most breast cancers are diagnosed after age 50. It’s important to have regular breast screening, called a mammogram, when you are invited. The aim of mammograms is to detect breast cancers early, when they’re too small to see or feel.
In the UK, women aged from 50 to 71 are invited for breast screening every 3 years. Anyone who has symptoms or a family history of breast cancer is also eligible to have a mammogram.
How can I know what’s normal for me?
‘Look out for anything that’s different in how your breasts, armpits and nipples look and feel,’ says Dr Rosen. By checking regularly, you’ll become familiar with what’s normal for you regarding:
- skin colour
- skin texture
- feel and shape of your breasts
- look, feel or shape of the nipples
Most lumps aren’t cancer, right?
‘If you find a lump in your breast, you should always have it checked by a GP,’ says Dr Rosen. But a new symptom doesn’t automatically mean you have breast cancer. Around 9 in 10 breast lumps are benign.
‘It could be that you’ve simply got a cyst, or a fibroadenoma, which is a non-cancerous, solid growth of fibrous or glandular tissue,’ says Dr Rosen.
Most cysts go away by themselves and are nothing to worry about. But if a cyst is large or causing discomfort, the fluid can be drawn off. Fibroadenomas may also disappear over time. In some cases, surgery (an excision biopsy) might be needed to remove it.
What changes am I looking for?
Always consult your doctor if you notice any of the following changes:
- A new lump, bumpy area, swelling or thickening in one breast or armpit that’s different to the same area on the other side
- A change in the size, outline or shape of your breast
- A change in the look or feel of your skin, such as puckering or dimpling
- Nipple discharge (not milky, for example, if you’re breast-feeding)
- Bleeding from your nipple
- A rash or redness on or around the nipple area or a sore that doesn’t heal
- Any change in the position of the nipple – eg: becomes inverted, or is pointing differently
- Any new discomfort or pain in the breast (although pain is a rare symptom of breast cancer)
‘A monthly breast check will help you to become aware of how your breasts look and feel,’ says Dr Rosen. ‘It’s perfectly normal, for example, to have one breast that’s slightly bigger than the other. Most women have slightly asymmetrical breasts. What you’re looking for is anything that’s not normal for you. This means any changes and symptoms that weren’t there before.’
How to do a breast self-examination — a checklist
To check the look of your breasts, stand in front of the mirror with your shoulders straight and your arms on your hips. Observe the following:
- Are your breasts the same size and shape as usual?
- Are there any visible distortions or swellings?
- Are there any changes in colour or texture to your breasts, armpits or nipples? For example, are there any areas that look red, inflamed, crusty, puckered or dimpled? Is there any soreness, rash or swelling?
- Do you notice any indentations? This may be caused by a lump or tumour that’s pulling the skin inwards
- Has your nipple changed position; drawn inwards instead of protruding outwards?
- Check whether there’s any fluid or discharge coming out of your nipples eg: watery, yellow or bloody
Now raise your arms above your head. Notice how your breasts move while you do so. Are they moving in the same way as always? Breast cancer can make breasts less mobile. Keeping your hands above your head, look for any of the changes above.
Now check the feel of your breasts. Standing or sitting, use your right hand to feel your left breast, and your left hand to feel your right breast. If you are less mobile, you can also lie down. Now:
- Keeping your index and middle fingers flat and together, using circular motions, feel your breast – from side to side, from the collarbone to the top of your abdomen and from your armpit to your cleavage. Begin at the nipple, moving towards the outer edge of the breast. Make sure you cover the whole breast. Next do the same of your armpit area
- Do you feel any lumps, bumps or swellings?
- Does skin feel different than usual?
When to seek help from your doctor
‘If you find a lump or notice any other signs, always see your doctor as soon as possible,’ says Dr Rosen. ‘Try not to panic, as the vast majority of lumps are benign and there may be other reasons for them. Also, lumps that hurt are usually not cancerous but hormonal. Your GP will examine you and refer you to a breast cancer unit or clinic for further tests.’
How will I be tested?
If you have symptoms, you may be referred for a mammogram. You may also need an ultrasound scan, which uses high frequency waves to create an image of part of the body.
If breast cancer is suspected, you will have a biopsy, which examines cells taken from your breast to see whether they are cancerous. A needle biopsy (where a sample of tissue is taken from a lump) is the most common type of biopsy. A biopsy can also be done by needle aspiration, where a sample of breast cells is removed using a small needle.
If a diagnosis of breast cancer is confirmed, tests will be needed to confirm the stage and grade of the cancer, and the best method of treatment.
What about gene testing for breast cancer?
Certain types of breast cancer may be genetic. For example, if you have BRCA1 or BRCA1 genes, this may raise your risk of developing breast cancer, and ovarian cancer.
If you’re concerned, for example, if breast cancer runs in your family, and you’re worried you may also develop it, talk to your GP about genetic testing.
Not everyone is eligible and you would usually have to have good reasons to have this done. For example, if a relative has already been tested and shown to carry the BRCA1 or BRCA2. Testing is often inconclusive. You may also need to consider whether you really want to know, as a positive result may cause ongoing anxiety.
Start with a discussion with your GP about your family history and they will help you decide on next steps.
This article has been reviewed by women’s health specialist Dr Elisabeth Rosen
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