|
Magazine
Breast Self Examination: A safety net
THERE is a rising incidence of breast tumours in India. Fortunately, the majority of these are benign and only a comparative minority are cancers. The incidence of breast cancer in India is estimated at approximately 9,000 cases a year. This is in sharp contrast to the developed countries where the annual incidence is estimated to be more than 5,50,000 cases.
Today, benign breast problems outnumber cancer by a factor of 10 or more. They are a source of enormous concern and fear to the Indian woman. But easy and dignified access to health care systems for expert examination, investigation, treatment and reassurance is limited.
Gender based discrimination and poverty within male dominated communities mean that a woman has to override cultural and quasi-religious barriers to seek appropriate health care. Indeed the only time most women in India get a breast examination done, if at all, is when they are pregnant or in labour or when facing difficulties with breast feeding. Though the number of Indian women with breast cancer is small , our public health care sector is still ill equipped to deal with even these limited numbers adequately. With limited resources both in terms of men and material, what preventive care can we offer our women?
The West with its high incidence of breast cancer can barely justify the expensive countrywide screening mammography programmes in an effort to save lives by tertiary prevention. But in India, neither science nor statistics allow us to introduce screening mammography as a valid preventive health exercise at a national level.
In an effort to offer help where none exists, the medical community has realised that Breast Self Examination (BSE) is a simple, no-cost defence tactic.
It is a health habit, which teaches a woman to be aware and discover problems at an early stage. It is a self-help technique, which bolsters a clinical support service by one's health care provider who can offer annual clinical examination.
All women should make BSE a habit from teenage onwards when the breasts begin to develop. BSE is best done every month, a week after the menstrual period. If a woman does not have periods (due to menopause or removal of uterus), then it may be done on a fixed day of the month.
Breast Self Examination technique is best taught by one's health care provider. The following guide merely reinforces and reminds one of what one has already learnt from the doctor or nurse.
Look at the breast
1. Undress to the waist and sit in front of a mirror, with your arms resting on your thighs. Or stand in front of the mirror with the hands hanging by the sides.
2. Observe the right and left breast mounds. Are they symmetrical? Is there a swelling? It is normal for one breast to be larger than the other.
3. Is there a change in the skin: redness, an orange peel appearance or puckering? If your breasts are large or if they sag, pull up the breast mound to observe the skin on the under surface.
4. Observe the right and left nipples and areola. Is there redness, scaling, indrawing of the nipple or discharge? Any discharge may have stained your undergarment.
5. Raise your arms above your head and recheck the above once again. Is there dimpling of the skin?
6. Place your hands on your hips and press firmly inwards. Is there dimpling of the skin or an abnormal deviation of the nipple? If the breast mounds are asymmetrical, there may be asymmetry or normal deviation of the nipple.
Feel the breasts
7. Feel the underarms for lumps, using the left hand for the right underarm and vice versa.
8. Lie flat on the bed or the floor, with a pillow under the head and right shoulder, with the right hand placed under the head.
9. Examine the right breast with the left hand, using the pads (not the tips) of the middle three fingers.
10. The area to be examined extends from the collarbone above to an inch below the breast margin, and from the midline to the side of your chest.
11. The breast is examined in segment arranged in an imaginary radial pattern centred on the nipple.
12. Small, slow, firm, overlapping circular movements are made by the fingers from the periphery towards the nipple, compressing the breast issue against the rib cage.
13. Begin feeling at 12 o'clock position from the top of the breast, working down towards the nipple. They move to the next vector at 1 o'clock, 2 o'clock and so on, till all vectors on the clock face are checked.
14. Place the right forearm over the forehead, roll slightly to the left and re examine the outer part of the breast, up to the armpit.
15. To examine the left breast, move the pillow to support the head and left shoulder. Use the right hand to examine the left breast as above.
16. Re-examine both breasts in the sitting or standing position when having a bath, as wet and soaped skin will enhance the smoothness of the examination.
17. Perform Breast Self Examination slowly and in a relaxed manner.
With practice, you will become familiar with the texture of the breasts.
18. Do not strip or squeeze the nipple to check for discharge. Look for staining of the undergarments from a spontaneous discharge. Spontaneous discharge is normal during pregnancy and breast-feeding.
19. If any finding during the examination concerns you, approach your doctor immediately for reassurance and further assessment.
20. A Breast Self Examination is a safety net in between routine and regular breast examination by an expert clinician.
Only your doctor can decide if you need regular mammograms in addition to the monthly BSE.
Compiled by DR. UMA KRISHNASWAMY
for The Hindu in public interest.
Send this article to Friends by
E-Mail
Magazine
|
