Breast cancer may be one of the causes of breast pain. You can self-examine yourself if you see breast cancer symptoms. Learn to self-examine from experts at Meri Sehat.

Breast Cancer | Symptoms | Self-examination | Meri Sehat

Breast Self-Exam: The Hows and Whys

Introduction

In Pakistan, 1 in every 9 women is at risk of developing <a href="https://www.merisehat.pk/disease/breast-cancer">breast cancer</a><a href="#accordion">[1]</a>.. Moreover, breast cancer is also the most frequent cancer among both men and women in the country, accounting for 14.5% of new cases in 2020<a href="#accordion">[2]</a>. Moreover, the country continues to have a high mortality rate from the disease.&nbsp; 
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Developing countries like Pakistan, despite the lower incidence, have a higher morbidity and mortality rate of breast cancer than developed Western nations. This contrast is due to a myriad of reasons namely: less number of screening and treatment facilities, women are often unaware of <a href="https://www.merisehat.pk/disease/breast-cancer">breast cancer symptoms</a> or treatments and delay seeking help. As a result, many are diagnosed at a later stage and have higher mortality rates. The situation can be reversed with increasing awareness and the widespread availability of&nbsp; breast cancer screening programs.&nbsp; 
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Although mammograms can help detect breast cancers even before one feels a lump, breast self-exams allow you to become more familiar with the anatomy of your breasts and identify any changes.&nbsp;

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Understanding how to perform a self breast exam

Before you begin a breast self-exam, it is always good to discuss the correct technique with a doctor and ask for a demonstration. 
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Since hormonal changes can cause breast changes, a breast self-exam should be conducted a few days after the end of your menstrual cycle. However, post-menopausal women can choose any day of the month. The exam should be done while standing and lying down. It typically begins with a visual inspection.&nbsp; 
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<ul>
	<li>Look In The Mirror: The first step of a breast self-exam is to stand in front of a mirror without your shirt and bra and look for any changes. The arms should be hanging by the sides while you assess the breasts for any swelling, skin changes, nipple changes, dimpling of the skin, redness, or nipple discharge. The same should be repeated with the arms raised overhead. Next, press your hands firmly on your hips to flex the chest muscles as you examine for any breast changes. Remember to visually inspect both the breasts. 
	&nbsp;</li>
	<li>In The Shower: Lathering the fingers with soap and water helps them glide better over the skin. Using the pads of your three middle fingers, press with different levels of pressure on each part of the breast and feel for any lumps or thickening. Next, massage the fingers in a circular motion as you move from one spot to another. The last step is to squeeze the nipples and check for any discharge. The entire breast should be examined from the collarbone to the armpit. You can use the right hand for the left breast and vice versa.&nbsp; 
	&nbsp;</li>
	<li>Lying down: The same steps should be repeated while lying down on the back with one arm under the head. In all positions, it is important to check under the areola and the armpit.&nbsp;</li>
</ul>

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The following signs and symptoms are often associated with breast cancer: 
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<ul>
	<li>painless lump near the breast or underarm</li>
	<li>the skin over the breast thickens or becomes red</li>
	<li>breast swells, becomes painful, or develops a pitted appearance like an orange peel</li>
	<li>a recent change in nipples (become inverted)</li>
	<li>nipples or areola become scaly, sore, or develop a rash</li>
	<li>bloody or clear nipple discharge 
	&nbsp;</li>
</ul>

Don&#39;t panic if you feel a lump or find any other abnormality. Several conditions can also cause breast lumps such as fibroadenoma, and fibrocystic breast disease, both of which are benign. However, do not ignore the lump and instead make an appointment with an expert to gain a professional diagnosis. 
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In Pakistan, 1 in 4 cases of hereditary breast cancer and 1 in 5 cases of male breast cancer is a result of the BRCA1/2 gene mutation<a href="#accordion">[3]</a>,&nbsp;Moreover, women with a BRCA gene mutation also have a higher risk of ovarian and other cancers. On the other hand, men with genetic changes are at a higher risk of prostate and other cancers. Therefore, if a family member has a gene mutation or a history of breast cancer, it is best to consult a genetic counsellor. They might suggest genetic testing to look for various gene mutations associated with breast cancer.&nbsp;

Conclusion

According to the American Cancer Society, the 5-year survival rate for all women diagnosed with breast cancer is almost 91%<a href="#accordion">[4]</a>. However, the survival rates are highly dependent on the stage one is diagnosed at, the type of cancer, the person&#39;s age, and several other factors. Early-stage diagnosis can help increase the five-year survival among these patients. Although the ACS does not recommend breast self-exams for cancer detection, researchers predict that a simple breast exam can detect around 60% of cases<a href="#accordion">[5]</a>. Hence, women are often advised to conduct regular breast self-exams to reduce their risk of delayed diagnosis. 
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In Pakistan, most women are unaware of breast self-exams. A study done in Islamabad, among newly diagnosed breast cancer patients, found that none of the patients with stage III and IV cancer had any concept of self-exams<a href="#accordion">[6]</a>. A lack of knowledge among women is one of the major reasons behind these statistics. Therefore, there is a need for widespread breast cancer awareness programs for women to reduce the disease burden among the population. 
 
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Key Points

<ul>
	<li>In Pakistan, breast cancer is the most frequent cancer among both men and women and accounted for 14.5% of all new cancer cases in 2020.</li>
	<li>Breast self-exams can help women understand their breasts better and timely identify any pre-cancerous changes. The examination should be done monthly while standing and lying down.</li>
	<li>While conducting a breast self-exam, one should look out for signs such as a painless lump near the breast or armpit, skin changes, breast swelling or redness, nipple changes, and any bloody nipple discharge.&nbsp;</li>
	<li>The majority of women in Pakistan are unaware of breast self-exams or breast cancer symptoms; therefore, there is a need for effective screening and health awareness programs for the population.&nbsp;</li>
</ul>

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[1].Sohail, S. & Alam, S. N., 2007. Breast cancer in pakistan - awareness and early detection. Journal of the College of Physicians and Surgeons Pakistan, 17(12), pp. 711-2.

[2].International Agency for Research on Cancer, 2021. Pakistan Globocan 2020.

[3].Rashid, M. U. et al., 2019. Spectrum and prevalence of BRCA1/2 germline mutations in Pakistani breast cancer patients: results from a large comprehensive study. Hereditary Cancer in Clinical Practice, 17(27).

[4].American Cancer Society, n.d. Breast Cancer Facts & Figures 2019-2020. , Atlanta: American Cancer Society.

[5].Weiss, N. S., 2003. Breast cancer mortality in relation to clinical breast examination and breast self-examination. The Breast Journal, Volume 9, pp. 86-9.

[6].Manzoor, A., Waqar, S. H., Janjua, A. & Shah, S. A., 2017. Breast Self-Examination Knowledge and Practice Among Newly Diagnosed Patients of Carcinoma Breast. J. Soc. Obstet. Gynaecol. Pak., 7(3).

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