What is my breast cancer risk?

The causes of breast cancer are unknown, but the disease seems to involve many factors. A woman has a higher-than-average risk of developing breast cancer if:

• She is over 50 years old
• Her mother or sister has had breast cancer
• She has had cancer before

What are some of the early warning signs:

Early diagnosis is one of the most reliable tools in the fight against breast malignancy. The earlier breast cancer is detected, the better the chances of survival and successful treatment. Some of the early warning signs include:

• A lump or thickening in the breast
• A change in breast shape, nipple retraction or skin discoloration
• Discharge from the nipple

Who should practice breast self-examination?

All women over the age of 20 should practice monthly breast self-examination. Regular breast self-examination can help you identify changes that occur between clinical breast examinations and mammograms performed by your doctor. By practicing careful and complete breast self-examination and by discussing any breast irregularities with your doctor, you can substantially increase your chances of early detection and early treatment of any problem.

Breast self-examination on a regular basis will help you get to know your normal breast pattern.

When should I conduct the breast self-examination?

Breast self-examination should be done once each month. If you menstruate, the best time is 10 days after the onset of your period, when your breasts are least likely to be tender or swollen. If your periods are irregular or have stopped, choose a day such as the first day of the month to practice breast self-examination. That way, you will remember to do it every month.

Women who are pregnant or breastfeeding, and women who have silicone implants, should continue to examine their breasts once a month. Breastfeeding mothers should conduct the breast self-examination after all milk has been expressed.

How do I conduct the breast self-examination?

The complete breast self-examination can be divided into three parts. Parts one and two are performed standing up, and part three is done lying down.

Standing Up - The Visual/Mirror Examination

1. While standing in front of a mirror, inspect both breasts for anything unusual (such as any discharge from the nipples or puckering, dimpling, or scaling of the skin). Look at your nipples to make sure they have not changed in any way.
2. Stand with your arms relaxed at your sides, and inspect your breasts in the mirror to check their shape and contour. Turn slowly from side to side, and continue to look for any abnormalities.

These next two steps are designed to emphasize any changes in the shape or contour of your breasts:

3. Watching closely in the mirror, clasp your hands behind your head and flex your elbows back, lifting your chest slightly upwards.
4. Next, press your hands on your hips and roll your shoulders and elbows forward, bowing slightly forward towards the mirror .

With each position, continue to examine the shape and contour of your breasts. Be alert for any changes from month to month.

Consult your doctor immediately if you notice any of the following:

• any discharge
• any puckering or dimpling of the skin
• a rash or unusual texture to the skin
• any change in nipple shape (an inverted or flattened nipple)
• any swelling or a lump under the skin
• a sore on the breast that hasn't healed

Standing Up - Applying Pressure or Palpation

During this part of the examination, you will check each breast for any unusual lumps under the skin. It is important to remember that most breasts feel lumpy and that you need to develop a good understanding of what is normal for you.

5. Raise your left arm. Place your first three fingers of your right hand together and press them firmly against the outer edge of your left breast so that you can feel the tissue beneath the skin. Beginning with this underarm area, press the pads of your fingers in small circles, about the size of a dime, exploring the breast tissue firmly, carefully, and thoroughly.

As you continue to palpate, and without lifting your fingers from the breast, gradually move your fingers to a larger circle around the entire circumference of the breast until you return to the starting point. This circle should go from the middle of the armpit up to the collar bone to the middle of the breast bone and across the underside of the breast. Once you've completed the first circle, then move your hand inward half an inch and continue palpating in smaller circles until you reach the nipple. Pay special attention to the area between the breast and the armpit, including the armpit itself. Use varying levels of pressure to examine the full thickness of breast tissue, and do not lift your fingers from the breast as you complete the exam.

6. Gently squeeze the nipple and look for a discharge. (If you have any discharge during the month, consult your physician.) Repeat the entire exam on your right breast.

Lying Down - Applying Pressure or Palpation

7. Repeat steps 5 and 6 lying down. Lie flat on your back with your left arm over your head. You may want to place a pillow or folded towel under your left shoulder; this will help compress the breast and make it easier to examine. Using your right hand, apply the same careful circular motion described above.

When you have thoroughly palpated the left breast, perform the same examination on your right breast.

Remember:

Monthly breast self-examination, annual clinical examination by your physician, and annual mammography is the most positive defense against breast cancer.

Breast cancer cannot be prevented, but survival is better when detected early and properly treated.

Contact your doctor if you experience a change in either breast.