THE incidence of breast cancer in India is mercifully low at about 9,000 cases per year when compared to the incidence in the developed countries which goes up to around 50,000 cases per year. Despite this, there has been a constant information blitz on breast cancer, often with an uncritical acceptance of "western" health policies on breast cancer prevention for Indian women.
This cult of fear has led to a disastrous emotional psyche, wherein every Indian woman developing a breast symptom believes herself to have breast cancer and will all too willingly subject herself to expensive and inaccurate evaluations and assessments to rule out a cancer.
"Let us be safe and get the tests", " Let us operate and rule out a cancer" her doctor tells her, and the woman and her family comply, paying a heavy emotional and economic price for reassurance.
If a doctor, dictated solely by scientific evidence of the highest statistical validity and veracity, were to advise an Indian woman about the prevention of breast cancer, what points would be stressed?
If the risk is deemed to be high, appropriate preventive action, including clinical and mammographic surveillance will be recommended. Preventive measures are not 100 per cent reliable. Access to such level of expertise is limited in India.
Look at the breast
1. Undress to the waist and sit in front of the 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 scaling, redness, 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 a 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 tissue against the rib cage.
13. Begin feeling at the 12o'clock position from the top of the breast, working down towards the nipple. Then move to the next vector at 1o'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 left 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 self-breast examination slowly and in a relaxed manner.
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 examination concerns you, approach your doctor immediately for reassurance and further assessment.
20. A breast self-examination is a safety net 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
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