Breast cancer is the most common cancer diagnosed in women. However, cases can be reduced with increased awareness and simple interventions such as breast examinations and seeking treatment early.
Here’s what you need to know about breast examination.
At what age should a woman perform breast exams and why?
If you are aged 20 and above, it is important to examine your breasts every month. This enables you to identify any alarming signs or changes in the breast and if treatment is needed, it can be started early.
When should I examine my breasts?
You need to do this at the same time each month as they will change in shape and feel different during your monthly cycle.
One to two weeks following your monthly period is the best time. If you have reached menopause, the examination could be done on the first day of each calendar month.
During the first examination, you should note the normal size and shape of each breast, the feel of the breasts (either one being larger or higher than the other is normal) and the position of the nipples.
Knowing your body well makes it easier to spot any changes.
How do I examine my breasts properly?
Undress and stand relaxed in front of a well-lit mirror with your arms by your side. Turn from side to side for a complete view of the breasts and make sure that the part of the breast going towards the armpit feels normal. Take your time.
You need to know where the boundaries of the breasts are. They should be recognisable below the nipple and on the inner side of the breast, and the upper and outer parts should fade into the skin.
Imagine your breast shaped like a water droplet with the top stretching towards the armpit and sometimes extending into it.
Check for any changes in shape or size, as well as discolouration, prominent veins or whether either nipple is turned in.
With your hands on your hips, look underneath your breast, then push your hands inwards towards the hips until you feel your chest muscles tighten.
Look again at your breasts while you keep pressing and note any creases of the skin or retraction of the nipples.
Place your hands lightly on top of your head and again look at your breasts carefully. This position emphasises any differences in size or shape of the breasts.
Now concentrate on the nipples and look for any excessive upward or outward change of either nipple.
Stretch your arms high above your head. Again, this emphasises any differences between the two breasts. Finally, look down at your breasts and squeeze each nipple gently to check for any unusual bleeding or discharge.
Make sure that the top part of your arms is not swollen.
How do I feel my breasts?
Many women who have not reached menopause have rather lumpy breasts just before their periods and for some women, this may persist for the whole month. In such cases, it's easier to detect unusual lumps during examination.
Lie down comfortably on a flat surface with your head on a pillow and slightly use your right hand to examine one breast at a time.
With your left shoulder raised, feel your left breast using the three middle fingers of your right hand. Keep your fingers flat and close together.
Start from the collar bone above your breast, pressing the breast gently but firmly towards the body, tracing a continual spiral.
Move your fingers in small circles, working right around the outside of the breast. Continue to work systematically over the whole surface of the breast, checking for any lumps.
Now place your arm comfortably above your head with your elbow bent and carefully repeat the examination of the whole breast, paying attention to the outer part which can now be felt with more certainty.
You may find a ridge of half-moon-shaped firm tissue under your breast. This is normal. Finally, examine the tail of the left breast ensuring that you go right up into the hollow of the armpit. Repeat the same for the right breast.
If you suspect something is wrong, consult your doctor without delay.
What should I look out for?
• Unusual difference in size or shape of the breast
• Alteration in position of either nipple
• Dimpling of the skin surface
• Unusual rash on the breast or nipple
• Unusual discharge from the nipple
• Unusual discrete lump or nodule in any part of either breast
Dr Mutebi is a consultant breast surgical oncologist at Aga Khan University Hospital, Nairobi.
