Anita B (34), a homemaker and mother of two from Bengaluru, is regular when it comes to breast self-examination. She follows the guidelines given by her doctors to check for signs of tumors. “My family history of cancer puts me in a high-risk category. So, I have been doing regular breast self-examination for a decade,” says Anita, whose parents succumbed to cancer.
In 2021, she noticed a marble-sized lump near the armpit and panicked. “I rushed for a clinical examination. To my relief, it was only a heat boil and it subsided in a week,” she says. Apart from self-examination, Anita regularly consults experts and gets a mammogram and ultrasound based on their advice.
Breast self-examination (BSE) is an effective method that can detect breast cancer. Mammography, clinical examination and breast ultrasound are the other breast cancer screening methods that women must conduct based on age and risk category.
Dr Lopamudra Das Roy, a cancer research professor, who is also the founder and president of Breast Cancer Hub says that when done correctly, BSE can detect anomalies like lumps at an early stage.
When to do a breast self-examination
Most experts recommend that BSE must begin at the age of 17. However, Dr Zareena Khalid, senior consultant gynaecologist, Aster Medcity, Kochi, Kerala says, “Girls who have attained puberty must begin breast self-examination from the time they attain puberty.”
The best time for breast self-examination is between the seventh and eighth day from the first day of the menstrual cycle. Avoid examining after or before this because the breasts can be tender or lumpy due to hormonal changes, explains Dr Nirmala Chandrashekar, gynecological oncologist, BGS Gleneagles Global Hospital, Bengaluru.
How to do a breast self-examination
Breast examination is best done standing shirtless in front of the mirror. While one can examine breasts by lying down sideways too, it may not give an accurate diagnosis, says Dr Khalid. She adds, “The breast muscles cannot be tight while lying down.”
A complete breast examination includes examining the armpit area for any inflammation of the breast lymph nodes.
Dr Nirmala further adds that the nipple is another area that has to be examined. “Any discharge which is red in colour needs clinical examination,” she adds.
Steps to do a self-breast examination:
- Stand shirtless/braless in front of the mirror with breast and chest relaxed.
- Check the right breast with the left hand and vice versa.
- Raise the arms behind the head to ensure the muscles are tight.
- Examine using four fingers (excluding the thumb) by gently moving the fingers in a circular motion from the upper to the lower part of the breast.
- Examine the armpit region for any inflammation in the breast lymph nodes
- Look for colour changes, inflammation, puckering (wrinkled and pulled skin) or depression (dimpled skin), moving or static thick lumps, redness and nipple discharge.
- Avoid using fingertips. Do not pinch or poke the skin using the thumb and forefinger.
All women must do a BSE
All women, especially those at risk must regularly do BSE and other clinical tests to ensure early detection and treatment.
“Hysterectomy (partial or total removal of uterus), ovariectomy (removal of ovaries) or menopause (end of menstrual cycle) does not reduce the risk of breast cancer,” explains Dr Nirmala.
“Breastfeeding mothers who experience a white discharge six months after weaning must get examined by an expert immediately,” advises Dr Nirmala.
How often must one do breast self-examination?
“All women must do a breast self-examination once a month,” says Dr Rakesh Ramesh, surgical oncologist, St John’s Medical College Hospital, Bengaluru.
Those who have a genetic mutation (mutations in the BRCA1 and BRCA2 genes) or a family history of cancer must complement BSE with a clinical examination after puberty.
“Other women must conduct a clinical examination with regular BSE once in three years until 30 and annually beginning at age 40,” explains Dr Ramesh.
Mammogram: Mammogram (X-ray of the breast) is a must along with BSE and clinical examination after 30, say experts. Dr Ramesh explains, “While those who are not at risk can do annual mammograms after 40, those with a family history of breast or ovarian cancer must do annual mammograms from 30.”
Breast ultrasound: When breast tissues are dense, a mammogram may not detect tumors in the deeper structures of the breast. “An ultrasound (imaging test to extract the images of the internal structure of the breast through sound waves) must be complemented with a mammogram in these cases for accurate diagnosis,” says Dr Ramesh.
BRCA test: Three percent of breast cancers every year are due to genetic mutations, says CDC. Getting a BRCA test helps understand genetic mutations, says Dr Nirmala. This is highly recommended for women who have a family history of breast cancer due to genetic mutations. She adds, “If results from this one-time test are positive, one must do a breast ultrasound, breast MRI and other tests annually to ensure early diagnosis.”
Breast cancer in men
Men are at risk of breast cancer too. According to World Health Organisation data, Approximately 0.5–1% of breast cancers occur in men. Men must also examine the following changes in their breasts once every year, says Dr Nirmala:
- Swelling or firmness in the breast or chest region
- Changes in skin texture or redness
- Moving or static lumps
- Nipple discharge
Not every lump is cancerous, say experts. According to WHO, in 2020, breast cancer emerged as the world’s most prevalent cancer with 7.8 million women being diagnosed, and treated for breast cancer.
Early detection can only increase the survival rates and it can begin in the comfort of your home.
- Post puberty, girls must begin breast self-examination.
- Self-breast examination must be done once a month.
- Men are at risk of breast cancer too.
- One must look out for colour changes, inflammation, wrinkled or dimpled skin, thick lumps, redness and nipple discharge.