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The 'A B C' of breast cancer self-checks

The importance of carrying out regular breast checks is something that all women (and men) are being encouraged to remember this Breast Cancer Awareness Month. Despite what the name implies, however, there are more stages to completing these vital checks than we’d be forgiven for thinking necessary. According to Dr Nagete Boukhezra, General Practitioner at the Private GP, London Doctors Clinic, it’s equally important to check the armpits and the collar bones, and not just the actual breast tissue. Worryingly, these surrounding areas are very often overlooked.

This in mind, it’s helpful to remember the ‘ABC’ rule when carrying out your regular self-checks A - Armpits B - Breasts C - Collar Bones Dr Nagete Boukhezra gives full details about how to carry out thorough examinations below:

'Ideally, self-breast examination should be done every month. The best time is at the end of your period when the breast is not so swollen. If you are pregnant, your periods are irregular or you no longer have periods, you can choose a specific day each month that is easy to remember.

To begin with, you need to know how to examine your breasts. It only takes a couple of minutes to check east breast. Lie on your back and try get your breasts to lie as flat as possible on your chest - it may be easier and more comfortable if you put a pillow behind your shoulder or back. If you start with the right breast, put your right arm behind your head. Then, move the pads of your left fingers, keeping them flat and together, around your right breast gently in a small circle from the outside to the centre, checking the whole breast and armpit area. With each little circle, change the amount of pressure from light to medium to deep to assess all levels of the breast tissue.

The armpits and the collar bones are often overlooked, so take additional care to check the surrounding areas. Also ensure you check your nipples for any discharge - lumps can hide directly beneath nipple, so take care to check here too. Once complete, simply perform the same steps on your left breast.

Once you’ve done the physical check, take the time to look closely at your breasts standing in front of a mirror with your arms at your sides - and then again with your arms up. Check for changes in the appearance of your breasts such as redness, swelling, dimpling of the skin and changes in the nipple.

Repeat this exam every month so that you know how your breasts normally look and feel!'

Q&A with Dr Nagete Boukhezra

Can I rely on breast self-exams alone?

Mammography is only available to women over 50 on the NHS. Self-examination is often the only way women under this age detect tumours.

What should I be looking out for?

It’s important to be on the lookout for breast lumps of all types. Breast lumps can be solid or soft. They can be unmovable or movable. They can range in size from a pea sized lump to much larger and can vary in levels of pain as well. The only way to know for sure if the lump is benign is to seek medical advice.

What does it mean if I find a lump?

If you find a lump, don't panic, 8 out of 10 lumps are not cancerous. Most lumps are benign breast conditions, which are treatable, and some will even go away on their own.

Are there any other symptoms to look out for, other than lumps?

There are other signs that can point to breast cancer. For example, changes in the breast size, shape, or a swelling in your armpits or around your collarbones can be other signs to look out for. It is also really important to inspect your skin looking for a rash or changes in texture. The nipple examination is essential as changes in their appearances (inverted nipple) or nipple discharge are other symptoms that we investigate.

Although breast cancer does not usually come with a pain, discomfort in your breast is a sign to look for as well.

What should I do if I notice any of these symptoms or discover a lump?

Tell your GP, who will examine you and also ask about your family history. If your GP thinks your symptoms need further investigation, they will refer you. However, not all breast lumps require additional tests. If for example, your GP suspects a benign lump related to hormonal changes, they may want to check your breast again at the end of your period to see if the lump has disappeared.

What else do I need to know?

One in nine women will develop breast cancer, and it is more common in women over the age of 50 years old. The NHS Breast Screening Programme in England provides 3-yearly routine breast screening to women 50 years and older. Women at increased risk of breast cancer (for example with a strong family history) may be eligible for breast screening before 50 years of age.

Breast screening uses mammogram to detect small changes in the breast before other symptoms or signs of breast cancer. Breast screening detects about 30% of breast cancers and is estimated to save 1300 lives per year in the UK. If breast cancer is found at an early stage, there is an increased chance of breast-conserving surgery and a better prognosis of long-term survival.

The exact causes of breast cancer aren't fully understood and at the moment it's not possible to know if it can be prevented. However, there are certain factors known to increase the risk of breast cancer.

These include:

  • Age – the risk increases as you get older

  • Family history of breast cancer

  • A previous diagnosis of breast cancer

  • Excessive use of alcohol

Although you cannot prevent cancer, some habits that can help reduce your risk are:

  • Maintain a healthy weight

  • Stay physically active

  • Eat fruits and vegetables

  • Do not smoke

  • Limit alcohol consumption

Photo: Bralet by Jockey

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