Self Examination Screening in Vijayawada
Allow us introduce to you to 'The Breast'
Each breast is truly one of a kind, even in the same woman.
Breast is an organ in a woman's body, essentially for breast feeding but it also plays a part in defining the feminine structure. The breasts start to develop after 9 years of age normally, though this may vary in some girls. The composition of breasts is mainly fat and glandular tissue (i.e. the milk producing system). The breasts are different in each woman and will keep changing during a woman's lifetime with age, body weight, lifestyle and hormonal influences.
Given the changes that take place in the breasts, it is important for each woman to know what her normal breasts are like. This can be done by doing a breast self check.
Breast Self-check
Being breast aware helps us tackle small surprises better, if any, along the way.
Why- To know what is normal.
A part of woman's care routine must include staying aware of their breast health.
For - Women from the age of 20 years.
When - Once in every month.
Choose a time when your breasts are least likely to be tender or swollen. Many women find that the week after their period ends is the best time. Women with regular periods, check in the week after their period ends. With irregular menstrual cycles or women no periods, mark a fixed date in a month that you can remember, and check on that day every month.
How -
a. In the shower - Check your breasts while standing or sitting In the shower, raise your right arm and place your right hand behind your head. Apply soap, then using the pads of your three middle fingers on your left hand, press gently but firmly on your right breast. Move your fingers in a circular motion, covering the entire breast and armpit area. Repeat on your left breast.
b. In front of the mirror - With your arms at your sides. Look for any changes in the shape, size, or colour of your breasts and the skin over the breasts. Observe for a minute.
c. Lying down - Lie down with a pillow under your right shoulder and your right arm behind your head. Apply lotion or oil, then using the pads of your three middle fingers on your left hand, press gently but firmly on your right breast. Move your fingers in a circular motion, covering the entire breast and armpit area. Repeat on your left breast.
Avoid -
Do not try to find changes that may not be there. Do not squeeze the breasts or check for nipple discharge randomly without reason.
Report any changes to your doctor -
If you notice any new changes in your breasts during a breast self check, consult a breast specialist or your doctor.
Remember, most breast changes may not be cancer, but it is important to have them checked out.
Breast self check needs to be developed to become a lifelong habit, like brushing teeth. You could consult a breast specialist, if you are unsure about the way your breast feels. An expert opinion could clarify your view and ease your mind off any doubts.
Know When to See a Breast specialist
Any changes in your breasts you must consult a doctor. Things to look out for:
- 1) Lump in your breast or underarm.
- 2) Changes in the size or state of your breast.
- 3) Changes in the skin over the breast.
- 4) A nipple changes or inverted nipple.
- 5) Redness, soreness, or rash on the breast.
- 6) Unexplainable discharge in the nipple, particularly if bloody.
These symptoms do not generally mean you have cancer, however, they do need to be evaluated by your doctor.
Screening
Screening is a routine checkup for women above the age of 40 years. It can include a physical examination by your breast specialist or gynaecologist and a mammogram (an x-ray of the breasts) with ultrasound scan of the breasts, when necessitated.
A mammogram can show changes that are not felt by hand. Digital mammography provides better imaging with lesser radiation. Depending on the type of breast tissue and breast tissue changes, women are advised to have screening mammograms every one or two years.
Screening is for women who do not have any obvious problems in their breasts during breast self checks. It is important to have regular breast screening, so as to detect changes early on, because breast cancer is the most common cancer in women, and early detection can possibly reduce the treatment and improves the end result.
Screening is also performed for women with strong family history of breast or ovarian cancers, to ascertain if they are at high risk. Screening for women below the age of 40 is usually carried out using an ultrasound scan.
Screening can identify changes in the breasts, majority of them are not cancer. There can be physiological changes that appear with age and hormonal effects. A breast specialist can help you understand these changes and suggest the best way to proceed for you.
Diagnosis
When an abnormality in the breast is observed on self examination or a clinical examination, and mammography/ ultrasound confirm that there is a lump, the breast specialist or surgeon will discuss this finding with the woman in concern. The need for further evaluation is decided based on the symptoms and the imaging findings. Biopsy of the lump is decided considering multiple factors, one of them being the type of lump. A biopsy is the gold standard for arriving at a diagnosis.
Tests to evaluate your condition may include:
Mammogram
A mammogram is an x-ray of the breasts, one of the imaging modalities used for breast evaluation, performed by the radiology specialists. Mammography can be done in different formats - analogue/ digital/ tomosynthesis. Of these, digital mammography is widely available currently and gives good quality images with lower radiation. Mammography has the ability to show small masses and calcifications and includes the whole breast.
Breast Ultrasound
A breast ultrasound is yet another important modality that is used to examine breast tissue. This is usually performed along with mammography, to provide a more accurate report by defining the characteristics of a lump. This device uses high-frequency sound waves that help in creating images of internal breast tissue. This device also helps the doctor to analyse whether the lump is a filled with water or a solid mass. Ultrasound does not emit radiation, hence, is safe for use also in pregnant women with breast problems and women below 40 years.
Breast MRI
MRI of the breast is not routinely requested. In cases, where clinical findings, mammogram and ultrasound are not conclusive, then an MRI can help pinpoint the problem in most cases. MRI is also used for monitoring women at high risk for breast cancer. In breast cancer, the extent of the cancer can be identified precisely, to plan for breast conservation surgery.
Biopsy
A biopsy means taking a sample of the lump. This is done under local anaesthesia, with a wide bore needle guided by an ultrasound, to target the lump under vision. The tissue obtained through a core or trucut biopsy is sent for pathological examination and reporting. This is an out-patient procedure.
Core needle/ trucut biopsy is the gold standard for breast lump diagnosis worldwide. The advantages of core biopsy is i) the ability to retrieve bits of tissue from the suspicious lump instead of cells taken with FNAC, ii) this provides better material for analysis and iii) further tests, if required can be done with the existing bits, eliminating the need for a re-biopsy. In some cases, where the lump is very small, less than 5mm in size, core biopsy even under ultrasound guidance may not yield enough tissue for examination.
There are other types of biopsies for breast lumps, depending on the expertise available. For calcifications, when indicated a stereotactic guided biopsy is done. Vacuum assisted biopsy may be done for benign and a few intermediate lesions, as per the standard guidelines.
Genetic Counselling/Testing
When a woman presents with a strong family history of cancers, or has been treated for breast cancer herself at a young age, or in women with particular subtypes of breast cancer, genetic testing may be indicated.
Initially, genetic counselling is done to assess her risk of developing breast cancer. Family history is recorded. Following counselling, if the woman falls under the high risk category and she is keen to undergo genetic testing, then genetic testing is ordered. There is always a good period of time between counselling and testing, to aid decision making. It is important to understand the implications of genetic testing on the person and her family before taking the final decision to go through.
It is advised to schedule an appointment for consultation, at the earliest, upon discovering something unusual in your breasts. Determining whether it is a benign (not cancer) or a malignant (cancer) breast lump is vital, for planning further management. Detection of cancer at an early stage and treatment is more likely to offer favourable results.