Breast Cancer

Lesson 1: ALL ABOUT BREASTS: Risks, Myths & BSE

TCYB (Take Care of Your Breasts)

I know there have been recent studies and some organizations have been questioning the value of breast self-exam and even the benefit of mammography - while the scientifically-trained part of my brain agrees with some of the information, the woman and breast cancer patient in me says "Do whatever you can to avoid this disease". So, here we go - some basic rules:

All women age 20 and over should do a monthly breast self-exam. (We'll get into the details in a minute).

Every women age 20+ (or younger if sexually active) should have an annual PAP smear.

Women at age 40 are recommended to go for a baseline mammography (the first of a series, to be compared to later in life). We get into a little more detail about "mammo" in another lesson.

If there is a family history of breast cancer, or you are at high risk, based on your ethnicity or known BRCA1 or BRCA2 mutations, mammogram may begin earlier in life. For those of us who are survivors with no known risk factors identified, it is suggested that our daughters get their first mammogram 10 years prior to our age at diagnosis. (I was 47; my daughter should go for her first mammo at age 37).

Every woman should have a clinical breast exam annually beginning at age 20. (This is letting the doctor do a good breast exam on you). This doesn't mean visiting the local walk-in clinic and having your height and weight checked and telling them that you feel well. It means that either your family doctor, your gynecologist or breast specialist will examine your breasts thoroughly.

OK, here we go - breast self-exam: BSE. Make a few promises to yourself, before we begin the details: 1) Do it every month 2) Get a friend started on a BSE program 3) Have your annual checkup, PAP smear and mammo (whatever level you are at)

BSE should be done on the same day every month. (That doesn't mean that if you pick the 15th and you are away and forget, you should skip it. The idea is to have your breasts be in the same part of your menstrual cycle each month when you do the exam.)

Try to pick a time halfway between your periods if possible and you are regular enough to do that. This seems to be the time when your breasts will be the least sensitive and you can get a good "feel" for them without worrying about hormonal changes which can lead to tenderness, fullness and sometimes, cysts.

Again, BSE has tons of advocates and some who dismiss the practice as non-essential, but until we have something perfect, it's better than nothing and it reminds you to be in charge of your own health. There are several methods of doing breast self-exam: in the shower probably comes to mind first, since we all receive those shower cards from every organization around. tudies have shown that may not be the best place to do the exam. You CAN do it in the shower, but it's also good to do it lying down on your bed or a couch and also standing up, dry-skinned.

This is going to sound like a lot of instructions and may seem complicated, but once you get the hang of it, you can do your monthly exam in a few minutes.

First, stand in front of a mirror, arms at your sides. Then look at your breasts. It's normal for them to not be exactly the same size - none of your matching parts are (one leg is longer, one arm, and so on). Is the color the same as always? Is there any redness swelling? discharge?

Now do the same inspection with your arms in the air, overhead, or clasped behind your head.

Third, do it with your hands pressing kind of tightly on your hips and lean a bit forward and re-examine again. In a few months, you will know every freckle, scar, pimple etc. on your body and this is a good thing.

Off the record, I wear glasses for distance and the mirror and my glasses throw me off, so I visually inspect my breast(s) for the above in the mirror and then I do the next inspections (hands overhead and on my hips) while looking down at my breast(s). It's not perfect; it's not what is recommended, but it is what works best for me. Remember, this is for your benefit: no one is going to grade you on how you do your BSE. Actually, no one is even going to know - this is YOUR "know your body" regime and YOURS ALONE. Also, squeeze each nipple gently to check for any unusual discharge.

Next comes the PHYSICAL EXAMINATION.

Get comfy on the bed and put a pillow under your right shoulder. Put the right hand behind your head. Take the pads of your 3 fingers (not the thumb or pinky) on your left hand and begin. The pads are the rounded mounds below your nailbed and above the first joint. We are going to make nice, leisurely, light touch, circles of the breast. Start at the outside part of your breast (I usually begin below the center of the breast at the ribcage) and make tiny circles (about the size of a dime) and cover your entire breast. A good visual to get you used to how this should work is take a handful of dimes and lay them on your breast while you are lying down. That's a lot of little circles you have to make. But, take heart! It goes quickly once you know what you are doing and it is only once a month and it is important. The circles should always overlap - this is so you don't miss any spots.

Don't like that method? Seems too tedious? You can do an an up and down pattern, too. Pick a spot to start with, do your "ladders" or lines up and down your breast till you cover the same area. (Personal note: I feel like you have more of a chance of missing some areas this way).

Third choice: Divide your breast up like a pie - into wedges or slices. Use the pads to move inward on each slice.

Next, we do it all over again with a little bit more pressure (medium weight). This should be enough pressure to feel it a bit. Lastly, with a bit more (heavy) pressure. This doesn't mean you should put yourself in pain or redden your own skin, but you do need to feel enough to feel below the surface of the skin.

When you are done, switch the pillow and switch sides. NOTE: Most women are much better with their dominant hand, (the one they write with). I know I am much better with my right hand and a bit spastic with my left hand, but I'm getting better.

When you are done with the BSE lying down, do the whole process again, standing up. Here is where most women do it in the shower - it's private; soapy hands glide along your skin really well. The downsides to the shower are you can't see as well in the steam and suds and some feel that the slippery fingers make it too easy to miss spots or miss feeling a lump. Others recommend standing up and using body lotion or baby powder to make it easier on yourself.

I recommend trying it all the ways and see what works best for you. When in doubt, you can ask your doctor what s/he recommends. There are great videos, books, online tutorials on BSE. All it takes is a little practice and patience.

A few more important reminders: your breast tissue extends up to your collarbone, so make sure your BSE includes that area - all the way up to the bones joining your neck, over to your shoulder. The tissue also goes under your armpit - the axilla, the area where some of your important lymph nodes are - so make sure to examine physically and visually under your armpits.

I confess that I do circle lying down and wedges standing up in the shower. I was worried about not "seeing" what I was doing and my breast surgeon told me that when he wants to do a really good breast exam, he closes his eyes! Sometimes the visual aspects of things disorts the real picture. He is confident enough in his clinical breast exams (he's probably done 100,000) that he trusts his hands to "see" for him. That doesn't mean you should skip the visual exam or not look at the breasts during the physical exam - it just means that there is no right or wrong way - like NIKE says, "Just Do It".

http://trfn.clpgh.org/bcis/GeneralInfo/b...