Most times, the changes that occur in our body could be a sign of an underlying medical condition. Many women may write off these changes as a sign of ageing. Is this partly because we choose to be in denial of a potential sign of cancer? Women, in particular those who aware of the statistics of the dreaded breast cancer, often choose to live with a façade that it occurs overnight. However, the heightened risk of breast cancer isn’t elusive. As with all cancers, breast cancer too can be detected early and treatment can be undertaken for better outcomes.

Find out if you are at a high risk of breast cancer and be vigilant about the early signs.

How often are women affected by this

According to the research and data collected by the Tata Memorial Hospital, breast cancer is the most common of all cancers and is the leading cause of cancer deaths in women worldwide. This cancer accounts for 1.6 per cent of deaths. Another recent study of breast cancer risk in India revealed that in the span of a lifetime, one in 28 women develops breast cancer. The study also pointed that one in 22 women in the urban areas was likely to develop breast cancer as compared to their rural counterparts where one in 60 was at risk in her lifetime. Indian women aged between 43 – 46 years are more prone to breast cancer unlike women in the west where the age group of 53 – 57 years is at the highest risk.

Risk factors of breast cancer

There are some risk factors that can be avoided and some that you can’t do much about. The non-modifiable risk factors are age, gender, number of first degree relatives suffering from breast cancer, menstrual history, age at menarche and age at menopause. The modifiable risk factors are BMI, age at first child birth, number of children, duration of breast feeding, alcohol, diet and abortions.

Most breast cancers are detected as a lump felt by the patient, while performing self-examination or during routine medical check-ups or mammography. Less commonly, the cancer can also be detected as a thickening inside the breast. Paget’s disease of the nipple presents with skin changes, including redness, crusting, scaling, and discharge. A few patients with breast cancer show signs of metastatic disease. Some of these signs could be a pathologic fracture or a lung disease.

During a physical examination, a lump is felt distinctly different from the surrounding breast tissue. More advanced breast cancers are characterised by fixation of the lump to the chest wall or to the overlying skin, by satellite nodules or ulcers in the skin. Matted or fixed axillary lymph nodes suggest tumour spread. Inflammatory breast cancer is characterised by diffuse inflammation and enlargement of the breast, often without a lump, and has a particularly aggressive course.

Diagnosis

Practising a monthly self-examination is one of the best preventive ways to find any new or changing lesions that might be cancerous or pre-cancerous. A woman should start performing this self-examination once she is in her 20s. The best time so do this is a few days after your period has ended since at this time the breasts are not tender.

Steps for self-examination

  • Stand in front of a mirror, using both palms [not fingers] palpate both breasts, one at a time. Check for any lump or growths.
  • Now, raise one arm over the head and with the other hand inspect if there is any lump in the armpit.
  • Repeat step 2 on the other side.
  • While facing the mirror, press the nipples and check if there is any discharge, irregularity, puckering or size difference. Puckering is when the skin on the breast starts getting tiny dimples, similar to the skin of an orange.
  • Do not neglect lifting the breasts and checking for any lumps under them.
  • Examine if there is any difference between the sizes of both breasts.
  • Now while lying down, using the first few fingers as a pad, move them in a circular motion and check again for growths. Check both breasts thoroughly.
  • Ensure you inspect the entire breast from the top to bottom, side to side. And also, from the collarbones up to the abdomen and the armpits to the cleavage.

What signs must one look for

Look for any unusual lumps, bumps, masses and obvious changes in skin color or textures on different body parts. Examine your skin and mouth very minutely. Watch out for any swelling, warmth, redness or darkening of the breast, change in the size or shape of the breast, dimpling or puckering of the skin. Also don’t ignore any itchiness, scaliness, soreness or rash on the nipple and new pain in any spot that doesn't go away.

In case you spot a lump, do not panic. 80 per cent of all breast lumps are benign, which simply means they are not cancerous. Normal changes in the breast tissue, infection or even medication can cause these lumps. Benign lumps are usually painless and rubbery, and move freely, if you pushed them around. However, to know whether a lump is benign or malignant, a thorough diagnosis needs to be done. For its identification, one needs to undergo clinical examination, radiological investigation and pathological examination as suggested by the doctor. Since very small lumps can be missed on self-examination, periodic examination by a gynaecologist is a must.

mammogramMammogram or mammography is another essential screening test. It should routinely be done by all women beyond 40 years of age, every three years if there is no high risk factor. However, if there is family history of breast cancer, or any other risk factor, the mammography should be done every year. It is a simple procedure that can be compared to an X-ray of the breast or for better sensitivity and specificity it may be associated with an ultrasound of the breast. For any nervous women, it should be noted that mammography doesn’t require any prior preparation. The whole procedure lasts for 10 – 15 minutes. It can be carried out at any time of month regardless of one’s menstrual cycle. If needed, a doctor may even carry out a ‘fine-needle aspiration cytology’ [FNAC]—a diagnostic procedure where a thin needle is inserted into the lump to sample cells for investigation under a microscope. This procedure is less traumatic as well as safe and sometimes eliminates the need for a surgery or hospitalisation. In fact, most of these screening tests and procedures are risk-free, so one must not feel overwhelmed or anxious.

Women at large have become aware of the ramifications of breast cancer. But it is crucial to self-examine—once a month or more as suggested by your doctor—so that you can identify every minute sign of breast cancer. Of course, no woman would want to hear the bleak news of a developed breast cancer. Hence, this article suggests that being prudent and simply sparing a few minutes on yourself could be a life-saving habit.

  • October is Breast Cancer Awareness month.

This was first published in the March 2013 issue of Complete Wellbeing.

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