Breast cancer detection – the earlier the better

All women > 20 yrs should resort to screening for breast cancer. The various options available, for breast cancer screening and their merits & suitability have been enumerated below.

Breast Self Examination (BSE)

BSE involves the performance of serial and systemic examination of the breast by individuals every month after each menustral cycle & can help in the early detection of small breast cancers. All women >20years should perform regular systematic examination every month. Learn the right technique of BSE.

Clinical Breast Examination (CBE)

Clinical breast examination done by a trained personnel can help in early detection of breast cancers and is probably the best method in our country.

The sensitivity of CBE less than that of mammography & is

• lower in premenopausal (70%),
• intermediate in perimenopausal (87%),
• highest in postmenopausal (93%)

CBE has a higher sensitivity in 40-49 yrs than 50-59 yrs

Most feasible method of mass screening India where the cancers occur in younger age groups with denser breasts and mammographic screening is costly.

Mammography

• Mammography aids detection of very small cancers
• Useful more often in postmenopausal age groups
• Not recommended for
• Is costly
• May miss some cancers that can be detected by CBE
• Mammography is not a confirmative test but can detect small abnormalities in the breast which further can be diagnosed with confirmation by cytology or biopsy.
• Mammographic Biopsy can be done for small lesions.

FNAC/ Needle Biopsy/Core Biopsy

All suspicious lesions should be confirmed with a Needle cytology or Needle Biopsy. This test is mandatory to confirm the existence of cancer and is required before any further treatment is given.

BREAST SELF EXAMINATION – THE CORRECT TECHNIQUE

Step 1

Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. Here’s what you should look for:

• breasts that are their usual size, shape, and color.
• breasts that are evenly shaped without visible distortion or swelling.
• If you see any of the following changes, bring them to your doctor’s attention:
• dimpling, puckering, or bulging of the skin.
• a nipple that has changed position or an inverted nipple
• (pushed inward instead of sticking out).
• redness, soreness, rash, or swelling

Step 2

Now, raise your arms and look for the same changes.

Step 3

While you’re at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge this could be fluid or Blood.

Step 4

Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few fingers of your hand, keeping the fingers flat and together.

Cover the entire breast from:

top to bottom- collarbone to the top of your abdomen, &

side to side—from your armpit to your cleavage

Follow a pattern to be sure that you cover the whole breast.

You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast.

You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn.

Be sure to feel all the breast tissue: just beneath your skin with a soft touch and down deeper with a firmer touch. Begin examining each area with a very soft touch, and then increase pressure so that you can feel the deeper tissue, down to your ribcage

The correct technique of palpation is with the flat of the fingers and not the tip of fingers

Step 5

Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in Step 4. Also feel for glands in your armpits.