Breast care and self-examination

Breast care and self-examination 2017-02-09T14:19:59+00:00

Understand your breasts

This Factsheet is designed to help you understand your breasts, resolve simple problems that might affect them, and identify if you need to seek advice from your GP.

Be breast aware

The earlier breast cancer is found and treated, the easier it is to treat. Breast cancers are diagnosed either due to women who notice new breast symptoms and are referred by their GP to their local breast unit for assessment and diagnosis, or are diagnosed in women who are eligible for and participate in the NHS Breast Screening Programme (NHSBSP). About one quarter of breast cancers diagnosed in the UK annually are diagnosed in women invited to attend from breast screening. Most women however who develop breast symptoms do not turn out to have breast cancer. Symptoms due to benign breast conditions that do not require any treatment other than reassurance once confirmed are far more common.

Being breast aware means knowing how your breasts normally look and feel at different times of the month. The best way to check your breasts is in the shower or bath as it is easier to notice changes if you run a wet / soapy hand over each breast and up under your arm. If you notice a change that is different from normal discuss this with your GP or practice nurse. Breast self-examination does not reduce the risk of dying from cancer but it is important to detect breast changes and avoid delaying seeing your GP.

A network of ducts spreads from the lobes towards the nipple. The breasts are made up of fat, connective tissue and gland tissue divided into lobes.

A network of ducts spreads from the lobes towards the nipple. The breasts are made up of fat, connective tissue and gland tissue divided into lobes.

The NHS breast awareness five point code is:

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

Breast shape and size

Very few women have completely symmetrical breasts. It is common for one breast to be slightly larger than the other. 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. If your breasts are naturally very unequal, this can be modified by plastic surgery but it is very important an opinion is sought from a plastic surgeon with recognised qualifications that can explain the risks and complications and provide appropriate post-operative aftercare.

Breast lumps

If breast lumpiness comes and goes with your menstrual period this is nothing to be concerned about. Do check your breasts again the following months a few days after your period is over. If you have a persistent breast lump or thickening of the breast tissue regardless of your age, or swelling in the armpit or around the collarbone you should make an appointment to see your GP.

Skin changes

Changes to be aware of include:

  • Puckering or dimpling of the skin
  • Redness or a rash on the skin of the breast and / or around the nipple.

Nipple changes

Changes to be aware of and request a GP appointment include:

  • A nipple that is pulled in or a change to its position or shape
  • Discharge from one of both nipples, including a blood-stained discharge.

Pregnancy and the contraceptive pill can make the nipple darken, even in dark-skinned women. This is nothing to worry about. Nipple discharge is an unusual sign of breast cancer; it is more likely to be due to a benign breast condition. Expression of milk from the nipple is common in pregnancy and can persist after breast-feeding has stopped.

Breast pain

Breast pain is a very common symptom, it can affect one or both breasts and it is unusual for it to be the sign of breast cancer.

If breast pain 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 or you have constant pain in your breast or armpit you should contact your GP.

There are three types of breast pain:

  • Cyclical breast pain is a symptom of normal sex hormone changes during the menstrual cycle. It is usually more noticeable in the week before the period starts, improves afterwards and can vary in severity. Women have described heaviness, tenderness, burning, prickling and stabbing sensations. It usually gets better without any intervention. It can be a side effect in the first few weeks after starting hormonal contraception and hormone replacement therapy.
  • Non-cyclical breast pain is not related to the menstrual period and the cause is uncertain. As for cyclical pain women can experience heaviness, tenderness, burning, prickling and stabbing sensations and it usually gets better without intervention.
  • Chest wall pain is usually musculoskeletal.

There are a number of self-help ways to help relieve breast pain.

  • Wear a good supporting bra, at night as well as during the day if necessary. If you have not been measured for a bra recently get this done.
  • Use simple pain killers including topical, ‘over the counter’ anti-inflammatory preparations if there is no contra-indication). This can help with non-cyclical and chest wall pain.
  • 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.

Breast screening

If you are registered with a GP and aged 50 to 70 you will be eligible for participation in the NHSBSP and invited by your local screening centre for a screening mammogram every three years. In England, by 2016 the programme will have expanded to include women aged 47 to 73. If you are over the upper age limit for automatic invitation you are entitled to have screening three-yearly but you will have to contact your local screening centre directly to request this.

The NHSBSP diagnoses 15,500 breast cancers annually in the UK and prevents about 1,300 breast cancer deaths.

There is debate about the over-diagnosis and treatment of cancers by the NHSBSP that would never have caused harm in a woman’s lifetime. It is estimated annually, for every breast cancer death prevented by the NHSBSP, 3 women will be over-diagnosed and have unnecessary treatment. Overall, the benefits from NHSBSP participation have been concluded to outweigh the risks. If you are eligible for screening and have any questions you should discuss these with your GP.

For information on the treatment of breast cancer look at the factsheet Breast cancer: risk factors.

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Useful contacts

Cancer Research UK

Website: www.cancerresearchuk.org

Breast Cancer Now

Weston House, 3rd Floor, 246 High Holborn, London WC1V 7EX
Tel: 020 7025 2400 Fax: 020 7025 2401
Website: www.breastcancernow.org

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

British Association of Aesthetic Plastic Surgeons

Website: http://baaps.org.uk

NHS Cancer Screening Programmes

Website: www.cancerscreening.nhs.uk

Menopause: Giving you confidence for understanding and action

Topics in the series include:

This fact sheet has been prepared by Women’s Health Concern and reviewed by the medical advisory council of the British Menopause Society. It is for your information and advice and should be used in consultation with your own medical practitioner.

Reviewed: December 2015

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

Registered Charity No. 279651

Website: www.womens-health-concern.org