Evaluation of Breast Problems That Women Can Do at Home

Introduction

For females, an easy way to assess their breast problems needs a few minutes. A female should do a simple checkup at home. If they notice any change then they should bring it to the doctor's attention immediately. The self-examination of the breast also helps to create an awareness about breast cancer and diagnosis.

What Is the Self-Examination of Breasts and Why Is It Important?

Self-examination of the breast refers to a screening method where the patient can do it simply in the comfort of home. A self-examination of the breast helps to understand the normal look and feel of the breast. Any changes from the normal features can be easily detected and can seek medical help. A self-breast examination helps in the early detection of breast cancer, which it will be easier to treat. Self-examination is not always the reliable method to detect cancer, still, a large number of women report their first sign of breast cancer.

What Is the Best Time to Do a Breast Self-Examination?

The examination should be done every month and the best time is a week after the period ends. During these days the breasts are not tender or lumpy like other days of the cycle. Try to do it at the same time every month.

How to Do the Breast Self-Examination (BSE)?

The steps of breast self-examination (BSE) that every woman should do every month are as follows.

• Start the BSE by standing in front of the mirror and looking at the breasts. Keep the shoulders straight and arms on the hips. Inspect the breasts for any change in size, color, or texture of skin on the breasts. Look for any swelling.
• Next, raise the arms and look for the same changes as mentioned above.
• Look for dimpling, puckering of skin, redness, swelling, or any unusual finding.
• While inspecting, also look at the nipples. Check for any signs of fluid coming out of one or both nipples.
• Now, palpate the breasts while lying down, using one hand to feel the opposite breast. Similarly, use the other hand to feel the other breast.
• Palpate the breast with the palmar surface of the finger with the hand flat. Make sure to cover the entire breast. Do not forget to palpate behind the nipple too as sometimes there may be a lump behind the nipple and no other abnormality in the nipple.
• Similarly, repeat the above step in standing and sitting positions as well.

What Are the Important Points to Remember While Doing the Breast Self-Examination?

• Using Pad of the Fingers - For proper examination of the breast use the pad of the finger and not the tip of the finger. If not able to do with a pad of the fingers, use other sensitive parts of the hand like the palm or back of the fingers.
• Pressure Levels - For breast examination use different pressure levels. Different depth of the breast is felt by different pressure levels. Light pressure to feel the tissue close to the skin, and medium pressure to feel a little deeper. A more firm pressure is needed to feel the tissue close to the ribs and chest. If doubtful, talk to the health care provider and do it correctly.
• Take Time - There is no fixed time or speed to do the breast examination. Keep calm, do not rush, and take enough time to finish the self-examination.
• Follow a Pattern - Use a correct clinical method for breast examination, as it will ensure that the entire breast is examined.

What Are the Changes to Be Noticed in Self-Examination?

The majority of women who come to the surgical outpatient department complain of either pain or lump in the breast or discharge from the nipple.

• Lump: If there is a lump, then the duration, size, and rate of growth of the lump have to be considered. Long-duration and slow growth are benign conditions. Whereas, short duration and fast growth could be a malignancy.
• Pain in the Breast: Breast cancer is a painless condition. Pain is the main complaint of acute mastitis. Pain associated with menstruation is seen with fibroadenomas.
• Discharge from Nipple: Bloody discharge could either be a duct papilloma or cancer. Greenish discharge may be associated with duct ectasia.

How to Evaluate After a Self-Breast Examination?

• Sometimes the presence of lumps or changes in the breast appears to be normal. These changes are due to different phases in the menstrual cycle.
• Do not panic, if a change or lump is noticed. Breasts appear to be different in different areas.
• Age-related changes are also visible in the breasts.

Make an appointment with the doctor, if noticing the following changes.

• Hard lump near the underarm.
• Thickening or fullness of breast on inspection.
• Change in shape of the nipple.
• Bulges or dimples on the skin.
• Redness, pain, or swelling of the breasts.
• Itching, sore, or rashes.
• Discharge from the nipple.

What Are the Special Investigations Done by a Doctor?

• Aspiration.
• Mammography.
• Ultrasound.
• Biopsy.

These are mainly done to differentiate breast cancer from other benign conditions, to detect an early cancer, and finally to know the stage of cancer.

What Is the Differential Diagnosis for Breast Changes?

1) Acute Mastitis: This is an infection of the breast that is commonly seen in lactating women. Symptoms are pain in the breast with redness. The breast is warm to the touch. Treatment is by antibiotics and if no relief is seen, a simple procedure to drain the pus formed is done.

2) Fibroadenosis: It is the most common breast disease. It is an estrogen-dependent condition where pain increases just before menstruation. Treatment is not usually required.

3) Fibroadenoma: It is a benign tumor seen in females below 30 years. It presents with painless swelling in one area of the breast. Treatment is the removal of the tumor if large, multiple, or recurring. Otherwise, it can be left alone with regular follow-up.

4) Duct Ectasia: It is associated with greenish discharge from the nipples which may be associated with pain. It is common in smokers. Treatment involves antibiotics and removal of the affected duct.

5) Ductal Papilloma: Blood-stained discharge from the nipple is common. It can be premalignant so further investigations are needed. Treatment is to remove the affected duct.

6) Breast Cancer: The most common symptom is a breast lump. But 90 % of breast lumps are not cancers. However, it is important to evaluate a case of breast lump since the earlier the detection, the better the survival. The second most common presentation is nipple discharge.

Conclusion

Breast self-examination plays a major role in the early detection and treatment of the condition. Hence, should be done monthly by all women ideally triple assessment is done by the doctors and includes clinical assessment, radiological imaging, and biopsy analysis. Treatment is a combined approach involving surgery, radiotherapy, hormone therapy, and chemotherapy.