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Breast care and self-examination

Understand your breasts

This factsheet is designed to help you understand your breasts, resolve simple problems that might affect them, and identify major causes of concern.

Breast shape and size

Very few women have completely symmetrical breasts. It is common for one breast to be slightly larger or a different shape from the other. If your breasts are very unequal, this can be modified by plastic surgery. If one breast suddenly gets bigger than the other, it could signal a problem such as an infection, cyst, fibroid or even cancer. See your doctor if this occurs.

Regular self-examination

It is recommended that instead of examining your breasts monthly for abnormalities, you should do more regular checks to know what is normal for you. Be aware of their appearance and texture, and note that these can change through the menstrual cycle. Once you are familiar with what is normal for you, look and feel your breasts regularly for changes. Report any changes to your GP without delay.

The breast awareness 5-point code

Know what is normal for you.
Know what changes to look and feel for.
Look and feel.
Report any changes to your GP without delay.
Attend for routine breast screening if you are aged 50 or over.

Too big or too small

Breasts are rarely perfect in their owner's eyes. Operations to enhance or reduce breast size should not be undertaken lightly. Counselling and a real understanding of the surgery involved is vital. Remember cosmetic surgery does not always match expectations and the results may not be as pleasing as you wish.

Breast pain

Pain in both breasts

If you have pain in both breasts and it varies with your periods, it is almost certainly nothing to worry about and is probably related to normal hormonal changes. However, if the pain is severe enough to interfere with your day to day life you may wish to contact your GP.

There are a number of self-help ways to deal with routine breast pain:

Wear a good supporting bra, at night as well as during the day if necessary.
Use simple pain killers. This can help if the pain is coming from the underlying muscles and ribs of the chest wall rather than the breasts themselves.
Try Evening primrose oil – two or three 500mg capsules a day. This often needs to be taken for at least 2-3 months continuously before any benefit is obtained.

Doctors can help with:

» Other hormones such as bromocriptine and danazol can be effective in treating breast pain but they are not without side effects, many of which are due to interference with ovulation and hence they can also upset the menstrual cycle.

Pain in one breast

This may relate to an accident, injury, or an infection. Breast pain is not uncommon in arthritic conditions of the ribs or even the neck. It may also be due to infection of the gullet or heart problems. Pain in one breast can also be an early sign of breast cancer although it is not a very common sign of this, so it important to see a doctor.

Nipple changes

Color: Pregnancy and the contraceptive pill can make the nipple darken, even in dark-skinned women.
Rashes: These are uncommon, though the nipple can be subject to eczema. A condition called Paget's disease that is cancerous can also cause a nipple rash. If you develop a rash or any unusual lump around the nipple, visit your doctor.
Inverted nipples: In mature women, the nipple usually points outward. It is not a cause for concern if a nipple is inverted – pointing inwards – from adolescence. But if a nipple turns inward during adulthood, a doctor's advice should be sought.
Discharge: Expression of milk from the nipple is common in pregnancy, and should occur from both nipples. Any bloodstained discharge must be checked out by a doctor. High levels of the hormone prolactin can make a woman who has never been pregnant apparently produce milk. This hormone imbalance can easily be treated.

Breast lumps

Intermittent lumps vary with the menstrual periods. Regular self-examination should always be carried out (see above), so you should be familiar with what is normal for your breasts. Any lumps that come up before a period normally disappear afterwards.

If you have a persistent breast lump regardless of your age, you should ask your GP to send you to a specialist breast clinic – not a general clinic – where all the necessary tests and investigations can be arranged with minimal delay.

Breast cancer

Each year more than 44,000 women are diagnosed with breast cancer. Although 11 out of 12 women will never get the disease, it is a common female cancer. If caught early, there is an excellent chance of recovery. Early diagnosis is all important. You can help yourself by being breast aware and getting used to the normal shape and size of your breasts. Look at them and feel them regularly.

Watch out for:

Dimpling or puckering of the skin
In-turning of the nipple
Differences in the position or shape of the nipple
Changes in the skin of the breast or nipple
A new lump appearing in the breast

All these may be signs of breast disease, which may or may not be cancer. In any event, don't sweep the problem under the carpet. See a doctor. Most women referred to a specialist breast clinic with symptoms do not have breast cancer.

Breast screening

In the UK, breast screening is available on the NHS for women aged 50 to 69 every three years. Screening reduces the chances of dying from breast cancer, but does not protect against developing the disease. If you have a breast problem and are too young to qualify for NHS screening, insist on a specialist assessment. Of all women who die from breast cancer, 20% are aged under 55.

For information on the treatment of breast cancer look at the factsheet 'Breast Cancer: Risk Factors'.

Useful contacts

Breakthrough Breast Cancer

Tel: 020 7025 2400

Fax: 020 7025 2401

Website: www.breakthrough.org.uk

Email: info@breakthrough.org.uk

Weston House, 3rd Floor, 246 High Holborn, London WC1V 7EX

Breast Cancer Care

Tel: 020 7384 2984

Helpline: 0808 800 6000 Mon-Fri 9am-5pm, or 9am-2pm on Sat

Website: www.breastcancercare.org.uk

Email: info@breastcancercare.org.uk

Cancer Backup

Helpline: 0808 800 1234

Mon-Fri 9am-8pm

Website: cancerbackup.org.uk

3 Bath Place, Rivington Street, London EC2A 3JR

This factsheet has been produced by Women's Health Concern and reviewed by members of our Medical Advisory Panel. It is for your information and advice and should be used in consultation with your own medical practitioner.

Review date: November 2007.

Women's Health Concern is an independent charity and receives no government funding.

Registered Charity No. 279651

Telephone advice line: 0845 123 2319

Email advice: advice[at]womens-health-concern.org (NB: please type @ instead of [at] in your email)

Website: www.womens-health-concern.org

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