Breast cancer

Breast cancer is the most common malignancy in females of the reproductive age group 20-49 in the world. One percent of breast cancer occurs in males too. It is the second most common kind of cancer in females in Nepal; the first being cervical cancer. It accounts for six percent of all cancers in Nepal.

There is not a single known cause of breast cancer. However, there is strong association of breast cancer with family history (five times likelier) and genetic factors, which are unpreventable. Other causes include exposure to radiation, ingestion of highly fatty foods, and estrogen-containing compounds like oral contraceptives.

Breast cancer is more frequent in the upper outer quadrant of the breast and in the left breast than the right. Studies have revealed that it is more common in women with no children (nulliparity) or women with first pregnancy at 30 years and above. Breast cancer generally occurs as a painless mass or lump whose further signs of advancement include dimpling of the skin, nipple retraction, bleeding from the nipple, fixation to the chest wall, conspicuously unequal breast sizes, and pain in later stages.

Self-examination

Breast self-examination is a simple, inexpensive, and risk-free screening method to detect signs of early breast cancer. It involves the woman herself looking at and feeling her breast for any possible lumps, distortions, or swellings. Detection of lumps at early stages leads to a better chance of survival.

Early detection of breast cancer is indispensably important as it offers prompt treatment, prevents metastasis (tumour migration), and improves the prognosis. Diagnosis can be made in varied ways. Mostly used preferred methods include monthly breast self-examinations, clinical breast examinations, mammography, and percutaneous needle aspirations. Mammography is a very effective and trustworthy method to detect breast tumors less than a centimetre in diameter. A supplementary procedure to evaluate breast abnormalities is ultrasonography, which, however, is not useful to detect smaller tumours.

According to the American Cancer Society guidelines for early breast cancer detection, women should begin to conduct a self-examination monthly from the age of 20, mammography at age 40, and clinical breast examination every three years for women between 20 and 40 and once a year after crossing 40.

Breast self-examinations should be conducted every month after the female reaches the age of 20. It should be performed about 7-10 days after menses. This is generally important because during menses, the breasts are usually engorged or swollen due to hormonal instability so the tumor can become difficult to detect. Menopausal women or women using contraceptives that cease menstruation are advised to perform breast self-examinations at regular intervals or on the same day each month.

The method

To conduct a self-examination, look for changes. First, keep your hands at the side and compare the breasts for symmetry. Observe any changes in shape, size or colour of the breast. Check for puckering, dimpling, or nipple changes. Then, raise your hands over your head and check the front and side views for symmetry, puckering, and dimpling. Gently squeeze the nipple and check for any discharges or bleeding. Again, keep your hands on your hips, lean forward and check for symmetry, nipple direction, and general appearance.

Now, feel for changes. Palpate your breast for any lumps or distortions. Lie down with a towel under your right shoulder, raise your right arm above the head and using the pads of the three middle fingers of the left hand, hold your hand in a bowed position and move your fingers in dime sized circles.

Generally two measures are employed for palpation. Breast can either be palpated by a ‘vertical strip pattern’ where the breast is palpitated from the underarm to the top of the abdomen and then back up to the neck line. Continue checking up and down, covering entire breast. The circular pattern is another method where the breast is palpitated from the nipple in a circular way towards the periphery in a spiral, checking the entire breast and armpit area. Use three levels of pressures: light, medium, and firm and cover the entire breast.

Now, check you left breast with your right hand in the same manner. Breast palpation can be done in a sitting or standing position. Always compare the findings with the opposite breasts. The self-examination can also be done while showering, ie, when the skin is wet and slippery. If any abnormalities (lumps, discharge, bleeding) are detected, immediately notify your healthcare provider. If you figure out any lumps, then it is important to be aware that 90 percent of lumps are just benign tumors and not cancer.

In conclusion, though major incidences of breast cancer are related to family history and genetic changes that are inevitable, certain environmental factors have also been identified that contribute to breast cancer, such as cigarette smoking, radiation exposure, and alcoholic drinks. Controlling them is of prime importance to decrease the risk factor of cancer. However, every female is at risk of breast cancer. Since the detection of cancer in early stages means a greater chance of survival, it is important to follow appropriate screening methods. It is also utterly important for a female aged 20 and above to carry out breast self-examinations monthly to be safe.

Makaju is a student of nursing at the Institute of Medicine