Know your breasts

Know your breasts

Oct 13, 2008
The Star

UNLIKE internal organs where cancers strike such as the ovaries, and intestines or even the lungs, breasts are in plain sight. It gives you the best chance of detecting a growth earlier than if the organ was inside you and this in turn makes treatment easier for surgery, chemotherapy or radiotherapy.

Until now, no direct cause for breast cancer has been found.

The best chance we have in combating breast cancer is secondary prevention - early detection. One way women can be familiar with their breasts is through Breast Self Examination (BSE).

Women should be aware of how their breasts normally look and feel (breast awareness) and report any new breast change to a health professional. Early detection saves lives and every woman from 18 years onwards is encouraged to practice BSE.

Even after treatment for breast cancer, a woman still needs to do BSE. Patients who have had breast cancer and have been treated may probably find this difficult because it will remind them every month of what they have gone through. But BSE should be a routine part of every woman's life.

Mothers should also talk to their daughters (at the appropriate age) about the importance of BSE so it will become a routine part of their lives.

The best time to do BSE is about three days after your period ends. This will allow your breast changes in the build-up to menstruation to "subside". If you no longer have periods, choose a date of the month and do it on the same date every month. The first day of the month is easy to remember.

For mothers who are breastfeeding, it could on the same day each month after nursing. If you are on oral contraceptives, do it on the day you start the next cycle of pills. If you are on Hormone Replacement Therapy (HRT), check with your doctor for the best time. (HRT formulations may vary).

"There is no need to feel paranoid by constantly touching or feeling your breasts as this will only generate anxiety. It is counter productive," explains Dr Evelyn Ho, President of the College of Radiology. "Develop a positive attitude. After all, you just want to check that your breasts are in good health. We normally look in the mirror to ensure that our lipstick is put on properly, and our hair is in place or the mascara is not 'running' - it's time to extend that below the neckline to give our breasts some attention as well."

Knowing your breasts - where it feels thicker, or bumpier, where there may be depressions, size, shape, colour, "flow", nipple positions and specific features of your own unique breasts - is essential. If you find a change that persists for some two menstrual cycles, you would want to go and get it checked with your doctor.

To have breast cancer, one does not have to literally feel sick either. "By the time they actually fall sick, the cancer would have spread to their other organs. So they live with their breast changes, lumps, until the skin ulcerates and still they continue to deny that they could be having breast cancer," adds Dr Ho, who has also written a book entitled, The Art of Being Breast Aware: Self Breast checks for the Beginners. The book is available in English, Malay and Chinese languages and can be obtained at the Breast Cancer Welfare Association and the Resource and Wellness Centre.

All said and done, a BSE is not a substitute for a Clinical Breast Examination (CBE) or a mammogram. Where in doubt, see your doctor. Otherwise, assuming one feels nothing wrong with oneself, a regular screening mammogram once a year or two years once would be good for women above 40.

"The gold standard in breast screening methods is still mammography, which has been shown to reduce breast cancer mortality by around 30% in the screened group, consisting of women aged 50- 69 years old, over a period of 10 years. With early detection, the chance of a cure is much higher," explains Dr Yip Cheng Har.

For women with early breast cancer, lumpectomy, which is preserving the breast instead of its complete removal (mastectomy), is possible, but only if the cancer is localised and not widespread.

"Mammograms will help us decide if the breast can be saved by doing a lumpectomy. Nowadays, MRI breast is increasingly being used in the West to determine whether the cancer is really localised. But it is not common practice in Malaysia yet because the MRI is a slow process and it is very expensive," notes Dr Yip.

Mammography is an x-ray image of the breast and is presently the most effective and accurate way to detect breast cancer at its earliest stages. A mammogram can pinpoint very small abnormalities before they can be physically felt. It usually takes as little as 15 minutes where the technologist will take two or more pictures of each breast after it has been gently compressed.

There are two types of mammogram - traditional film and digital. Both take an x-ray picture of the breasts. "Traditional film and digital mammography both use x-ray but digital captures the image on a computer, allowing radiologists and other health specialists to view and manipulate the images on high resolution computer monitors to enhance visualisation of the structures within the breast tissue," explains Harizal Hamed, Carestream Health country sales and service manager for Malaysia and Brunei.

"Both traditional and digital types are considered comparable although digital mammography may offer more benefits. For example, the patient losing her mammogram films or forgetting to bring them for her next mammography appointment will no longer be an issue if the hospital or centre has a digital image management system. The system transfers images to a computer so that they can be electronically stored."

There is no age limit to undergo a mammogram. If your doctor or radiologist suspects you have a cancer, and you are just 25 years old (and especially after a preliminary ultrasound of the breasts), a mammogram will very likely be done as well. It is recommended that women get mammograms regularly based on their doctor's recommendations.

To learn more about the steps you can take to perform Breast Self Examination, visit the College of Radiology website at: http://www.radiologymalaysia.org/breasthealth/index.htm

The Star/Asia News Network

This story was first published in The Star on Oct 12, 2008.