Women should love themselves more! Care for your breasts starts with self-examination

06 May 2022

As we age, various changes occur in every part of our body. From birth to old age, a woman's breast changes at different ages and stages of life. As a woman, it is important not only to pay attention to the aesthetic shape of the breast, but also to take care of its health.

What you need to know: Breast disease and health

Changes in the breasts occur at different times, from the beginning of becoming a woman, to becoming a mother, to menopause. When menstrual cycle begins, a woman's breasts begin to develop and grow larger, and some experience soreness in their breasts.

"The breasts also perform a very important task for women - breastfeeding. During pregnancy, pregnancy hormones increase to prepare her for breastfeeding. At that time, the size of her breasts will change, and pregnant women may experience swelling, soreness or a change in the feel of the nipples and breasts, and the nipples and areolas may increase in size or darken in colour. By the 16th week of pregnancy, the breasts will begin to produce milk and may have a watery or milky discharge," said Dr Wong Mei Wan, Consultant Breast and Endocrine Surgeon, Sunway Medical Centre, Sunway City. 

Changes in the breasts are common during and after pregnancy and will continue regardless whether a woman is breastfeeding or not. During the breastfeeding phase, some women experience some common breast symptoms, such as breast pain or swelling due to engorgement, as well as nipple leakage and soreness.

During menopause or perimenopause, there is a loss of elasticity in the breast tissue due to a significant decline in female hormones, resulting in a decrease in breast volume and density. Some women experience breast sagging and no longer have the sensation of full breasts. Irregular menstrual cycles before menopause may also lead to sore breasts. Regardless of the period, breast pain or soreness is common and does not necessarily mean cancer.

Pay attention to breast abnormalities

Perhaps you suddenly notice a change in your breasts and wonder: Is this normal? Does it happen to everyone else? Is this a normal change or a possible sign of disease? These breast-related issues are those you need to pay attention to.

Abnormal breast conditions include a lump in the breast that becomes hard and feels distinctly different from the normal tissue in the other breast or other parts of the breast.

The lump may be attached to the skin or chest wall and may persist or disappear. You may notice redness, wrinkling, or dimpling of the breast skin that was not present before, or abnormalities in the nipple area, such as scaly skin, sunken nipples, or a blood-colored discharge.

In addition to breast cancer, the most common cancer in women, other breast lesions include Breast Cyst, Fibroadenoma, Mastitis, Breast Abscess, Fibrocystic changes, and Galactocele.

Concerns of breast cancer patients

When a woman finds a lump, an investigation is needed to determine its cause. Benign breast lumps that are small (no more than 2 to 3 centimetres) and are not at risk of becoming cancerous do not need to be removed.

In contemporary cancer treatment, women diagnosed with breast cancer may choose to have only the cancerous tumour removed, rather than the entire breast. However, this option is only available for those with early-stage breast cancer who also need to continue radiation therapy after mastectomy. In the case of simple breast cysts and simple fibroadenomas, there is less risk of becoming malignant and the patient can have regular follow-up visits (semi-annually or annually) to allow the breast specialist to track changes in the benign tumour.

On the other hand, if your breasts feel swollen or tingly during non-menstrual periods, this is a common occurrence as it may be due to hormonal changes, improperly fitting bra or infection, so there is no need to worry too much.

Breast cancer risk groups and screening

Breast cancer is the number one killer of Malaysian women and the high-risk groups for breast cancer include:

Those with inherited BRCA1 or BRCA2 breast cancer susceptibility mutations, a personal history of breast cancer in the past, a history of precancerous breast lesions, and a family history of breast or ovarian cancer.

The Ministry of Health Malaysia's 2019 Breast Cancer Treatment Guidelines include the following screening recommendations for different age groups and those at risk of developing cancer.

  • Mammograms every two years for the general female population aged 50 to 74 years.
  • Women with a high risk of breast cancer who have no genetic variants detected may have breast ultrasound starting at age 30 to 39 and annual mammograms after age 40; and
  • Carriers of BRCA1, BRCA2 and PALB2 breast cancer susceptibility mutations should have an annual magnetic resonance imaging (MRI scan) at age 30 to 49 and an annual mammogram after age 40.

In case a pregnant woman finds out she has breast cancer, she should seek immediate medical attention, and her doctor will plan the appropriate treatment based on her condition.

According to a collaborative group study on how hormonal factors affect breast cancer, a woman's risk of developing breast cancer decreases by 4.3% for every 12 months of breastfeeding.

Pregnancy was also associated with a reduced risk of cancer, with women who became pregnant at full term at or before age 20 having half the risk of developing breast cancer compared to women who became pregnant at full term after age 30.

What you need to know: Breast care and examination

Women wear bras every day, but selecting and wearing the right bra correctly is a learning curve to avoid putting a burden on your breasts.

"Start by finding out the correct bra size for you to make sure your breasts are well supported. The cups should be able to cover the entire breast so that there are no bulges or gaps between the bra and the sides, top or bottom of the breast," said Chiew Lai Yee, nurse counsellor from Sunway Care Centre. 

In addition, comfortable, well-fitting undergarments will prevent back and breast pain, resulting in restricted breathing or skin irritation.

The bottom circumference of the undergarment ensures that it fits snugly at the back and is positioned low. The bottom should be parallel to the floor and not angled upward. If the underwire is too high, the bra will not provide proper support; a proper underwire should remain parallel around your rib cage throughout the day's activities.

Do steel underwire in bra cause cancer?

To make sure the underwire is not too tight, slide your fingers between the underwire and your breasts. If your fingers do not slide, the underwire is too tight and you may need a larger bra size. Also, make sure that the underwire does not strangle your breasts or skin and that it does not curve outward.

Some people worry that the steel ring of lingerie rubs and presses against the breasts, which can induce breast cancer over time. In fact, there are no scientific studies that show that steel ring underwear bras can cause breast cancer, and there are also no reliable studies that show any relationship between wearing or not wearing bra and breast cancer.

The breast is part of a woman's secondary sex characteristics, and patients who have undergone a mastectomy (removal of the entire breast) without breast reconstruction can wear silicone breast prosthesis and prosthesis-specific underwear with it.

Wearing breast implants that have the appearance, weight and texture of the breast also can help breast cancer survivors regain self-confidence, as well as improve weight or postural imbalances and shoulder sag caused by the removal of one breast. Some women undergo breast reconstruction surgery to recreate new breasts after removal of the breast.

Breast cancer patients need support

The most common questions patients ask include concerns related to physical changes, such as those caused by cancer treatments such as chemotherapy, radiation or surgery.

There are the scars that can result from surgical removal or reconstruction of breast tissue, as well as hair loss from chemotherapy, and even weight gain and early menopause for some patients. All of these physical changes can have an impact on self-image and confidence.

Therefore, patients need strong emotional support from family members, friends, and even breast cancer support groups. They need to share their emotional and physical experiences with other breast cancer patients or survivors so that they do not feel so alone in the fight against cancer.

Patients need to learn all about breast cancer and its treatments in order to understand and cope with the disease. In addition, patients also need to take care of their emotional health and take time to heal themselves and prioritise their overall emotional and mental health.

Patients can make some time for self-care and put their needs first, stay connected with other breast cancer survivors to gain a sense of belonging to a group, and practise positive thinking to reduce stress.

Yoga, meditation and other relaxation techniques can help patients to focus on themselves. Relishing old hobbies or exploring new ones is also a good way to go.

Breast cancer prevention

Reducing the risk of breast cancer starts with daily life, especially by adopting a healthy lifestyle and maintaining regular exercise habits is one of the best ways to help control weight. Being overweight can increase the risk of recurrence, especially for breast cancer patients.

Combining a balanced diet, for example eating more fruits and vegetables, drinking 2 to 3 litres of plain water daily, and moderate intake or avoidance of alcohol can help improve overall health.

Regular breast self-examinations are one of the most important ways to prevent breast cancer. The best time to perform breast self-examinations is 7 to 10 days after the start of your menstrual period.

You can also do it when your breasts are not too tight or swollen. If you are menopausal, you can do the examination on the same day of each month. Breast cancer survivors can also follow the above methods and times to do self-examination.

Steps of breast self-examination

Step 1
With your shoulders straight and your hands around your hips, observe your breasts in the mirror for any of the following.

  • Abnormal breast size, shape and color
  • Uneven shaped breasts with significant deformation or swelling
  • Stretching, wrinkling or bulging of the skin
  • Change in nipple position or nipple depression
  • Signs of redness, soreness, rash, or swelling
  • There is a visible lump

Step 2
Raise your arm and continue to observe changes in the breast area.

Step 3
Stand in front of a mirror and look for signs of fluid coming from one or both nipples.

Step 4
Lie down flat on your back and touch your breasts firmly and smoothly with the fingers of your middle three fingers, keeping your fingers flat and together.

Feel your left breast with the touch of your right hand, then feel your right breast with the touch of your left hand.

Apply pressure in a circular motion and move your fingers slowly, making sure to cover the entire breast.

You can start with the nipple and gradually expand the circles outward, or move your fingers from top to bottom and left to right, touching the entire area from your collarbone to the top of your abdomen and your armpits to your cleavage.

Carefully examine all breast tissues, using light pressure for surface skin tissues, medium pressure for deeper tissues, and heavy pressure for tissues close to the sternum and rib cage to feel.

Step 5
You can perform the self-examination while standing or sitting.

Many women find it easier to feel the breast tissue when the skin is wet, so they prefer to perform their self-examination in the shower, simply repeating the movements they made when examining while lying flat.

Source: Sin Chew