Breast Cancer: the importance of knowing your breasts

Breast cancer is the most common form of cancer to occur in women. In fact almost one in eight Australian women will get breast cancer in their lifetime. Nearly 20 000 Australian women and nearly two million women worldwide will be diagnosed with breast cancer every year. Tragically, over 3 000 Australian women and over 600 000 women worldwide die from breast cancer annually.    

According to Gold Coast University Hospital obstetrician and gynaecologist Dr Luke Waldrip there are a number of factors that increase your risk of breast cancer. These include:

• increased age;
• a family history of breast cancer, especially if they are first degree relatives;
• inheriting a gene abnormality such as the BRCA gene;
• obesity;
• starting menstruation before the age of 12;
• never having children or having your first child over the age of 30;
• using the oral contraceptive pill (though this risk goes within 10 years of ceasing the pill);
• using hormone replacement therapy for more than five years; and, surprisingly,
• being tall.

Moderate exercise and breastfeeding have both been shown to reduce your risk of breast cancer.

Breast Screening

Early detection of breast cancer by screening has been shown to increase survival and improve quality of life.

It is estimated in Australia that eight deaths from breast cancer will be prevented for every 1000 women between the ages of 50 and 74 who undergo routine two-yearly mammograms.

In Australia a two-yearly screening mammogram is recommended and offered to the general population between the ages of 50 and 74.

Breast Screen Australia will also perform, on request, screening mammograms for those between 40 – 49 and 75-plus, however these women will not receive invitations or reminders to attend screening.

It is important to realise that breast screening is a screening test only and it is not appropriate for investigation of changes in breasts, or new breast symptoms or signs. It is also important to realise that routine breast screening in women will still miss approximately 13 per cent of breast cancers that are present, hence the importance of seeing your general practitioner as soon as possible if there are changes in your breasts, or new symptoms or signs occur, irrespective of how recently you may have had a negative screening mammogram.  

Cancer Australia recommends that women of all ages are aware of how their breasts normally look and feel and that women report any new or unusual changes in their breasts promptly to their general practitioner.

Breast Self-Examination

Routine breast self-examination, although encouraged in the past, has unfortunately not been shown to decrease overall mortality from breast cancer.

The Royal Australian College of General Practitioners now acknowledges that regular breast self-examination cannot be recommended due to lack of evidence that it reduces mortality from breast cancer.

“The International Agency for Research on Cancer concluded in 2015 that routine breast self-examination was not effective in reducing breast cancer mortality,” said Waldrip. “So now bodies such as the Royal Australian College of General Practitioners and the American Cancer Society are encouraging all women to be ‘breast self-aware’. Being breast self-aware is not about following a particular schedule, but knowing what is normal for your breasts.”  

Being breast self-aware can involve looking at your breasts in the mirror on at least a semi-regular basis, as well as being aware of how they normally look and feel.

If there are any changes from what is normal for you, then you should see your general practitioner as soon as possible, said Waldrip. Changes to be concerned about include:

• a lump;
• swelling;
• change in breast size or shape;
• skin rash, scaling, dimpling, or puckering;
• nipple puckering or discharge; and or
• enlarged lymph nodes in the armpit.

Despite regular Breast Self-Examination no longer being actively encouraged, many women find the concept of being only “Breast Self-Aware” as somewhat vague and passive. Some women still prefer to perform formal Breast Self-Examination on themselves as a means of being breast self-aware.  

Breast Self-Examination involves three important steps: Look, Lift, Feel

Look

• Stand in front of a large mirror undressed from the waist up in a well-lit room with your hands on your hips
• Visually examine both breast from the front and both sides
• Check that your breasts are their usual size, shape and colour and that there is no nipple discharge

Lift

• Lift both your arms straight above your head
• Visually examine both breasts from the front and both sides
• Check that your breasts are their usual size, shape and colour and that there is no nipple discharge

       Feel

• This can be done either lying down or standing up
• Raise your right arm to behind your head
• Using your left hand, palpate the entire area of your right breast with the tips of your fingers from the underside of your breast up to your collar bone and under your right arm pit
• Using a methodical action use light, then medium, then firm pressure with the tips of your fingers in each area
• Follow a particular pattern to examine your breast, then your nipple, then under your armpit
• The particular pattern you use doesn’t matter, whether it be back and forth from the bottom upwards, up and down from the middle of your chest outwards, in a circular clockwise pattern, or radiating out from your nipple in a “pie-slice” pattern
• Then repeat the process, raising your left arm behind your head and examining your left breast, nipple and armpit with the tips of your fingers of your right hand

If you note any changes, or have any concerns, please see your doctor as soon as possible

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Suvi Mahonen is a Surfers Paradise-based journalist. Her work appears in The Australian, the Australian Quarterly, Mamamia and other health and lifestyle publications. Follow her on Facebook, YouTube and online art-selling platform Redbubble.