#teach your brain

What exactly is 'Awareness'?

Let me explain this by an example.

Most of the women whom I have operated upon for breast cancer, had come to me because they had found some 'lump' or a 'knot' or a 'hardness' in their breast, which was not painful. When any lady consults me for the first time for such a breast lump, I ask her, "Since how long do you know that the lump in the breast has been there?" Some women answer, "since 10 or 15 days", some women answer,"since two or three months" and some even answer "six to seven months". I do tests for them, cancer is diagnosed, and finally I operate upon them or send for other treatments, according to the stage.
Once the treatment is over, and they are all fine, I do make it a point to ask them "If you had known that the painless lump in your breast could be cancer, would you have come earlier to consult me? Would you have gone to a doctor within 10 or 15 days, instead of 2 or 3 or 4 months?" And most women answer to me, "Yes, Doc! Instead of wating for 3 or 4 months, with that lump in my breast, I would have definitely come to you much earlier, maybe in just a few days only, had I known that such a lump could be cancerous. I didn't come earlier because I did not know! I wasn't aware that this could be breast cancer!"

Does it make a difference if a lady comes in a few days, when she noted the 'lump' or if she comes after a few months after knowing that the lump is there in her breast? YES, it makes a big big difference! Every single day that a cancer remains in the body, it has the potential to spread. Also, by the time a 'lump' or a 'knot' is felt in the breast, it is usually almost 1.5 to 2 cm or more. If a lady waits, in a few months, it will become 3 to 4 cm (the stage will go up) and also spread faster.

Lesson Two: To detect breast cancer early, one needs to be aware. It is called 'BREAST AWARENESS'

Step 1: Read up about the symptoms of breast cancer

There are a few common symptoms of breast cancer: Breast Awareness simply means that you 'know' or you are 'aware' of the following:

A painless hard 'lump' or 'knot' in the breast

Sometimes, there is no 'lump' but a small area of breast feels 'harder' than the rest. This is called 'lumpish feel'.

Nipple is recently pulled 'inward' and cannot be pinched outward when we try to, as if sometihng is pulling it from inside. This is also called 'retraction' of the nipple.

The skin over some area or the whole of the breast has become thick - like a peel of orange (fruit).

A 'bloody' or 'blood stained' nipple discharge

Some 'knots' can be felt in the arm pit.

Plain and simple. The six symptoms above is all you need to know. If you wish to read some more details and understand the symptoms better, follwing are some pages where you can get a better idea (These pages will open in a new window. You can read, and close that page in your browser to come back to this page):
Symptoms of Breast Cancer
What is a breast lump?

Step One: Read up and remember the symptoms of Breast Cancer

Step 2: Perform a Breast Self Examination once a month

Make sure you remember the six symptoms above. Keeping in mind those symptoms, perform a Breast Self Examination once a month. The best time to do breast examination is just a few days after the menstrual period is over. The reason is, most women tend to have a bit of water retention and heaviness for a few days to a week before the periods, so examination during that time may miss out smaller lumps. After the periods, the swelling goes down, and so there is a higher chance of picking up a lump. For post menopausal women (women whose periods have stopped), one can do a self exmaination on a fixed date every month.
There are lots of videos on Breast Self Examination (BSE), you can look up on Google for them. Breast examination has to be done by the 'flat' of the hand, which means, keep your hand flat with the finger part on the breast, and with a rolling movement (clockwise or anticlockwise), feel the tissue of the breast with the flat of the fingers, first with slight pressure and lter, with deep pressure. Think of the breast, as a clock, with 12, 3, 6, and 9 O'clock positions.

First, examine the left breast with the right hand, in the lying down position, starting at 12 O'clock position (the top part of the breast), going clockwise, to bottom (6 O'clock), and back to 12 O'clcok; first at 12 O'clock, then at 2, then at 4, then at 6 and so on. Make sure you cover all the breast tissue, and nothing is missed out. Each time, roll the flat fingers in a round and round motion. In this examination, basically we are trying to look out for the six symptoms mentioned above - lump, lumpish feel, etc. Next, feel the nipple and pinch and see that it is not retracted. See that there is no discharge. Finally, push the hands in the arm pit and feel.

Second, examine the right breast with the left hand, in the lying down position, same way as above

Third, now stand up and stand in front of the mirror, first with both hands by the sides on the hips, and later both hands above, by the side of ears and observe carefully. Look at the shape of the breasts, look for any bumps, dimples, recent size differences. Specifically look at the direction of the nipples. They should point, usually, lower and outwards. If you see any recent change in direction of the nipple, please make a note. Look at the lower half of the breasts.

Fourth, in this standing position, examine the right breast with the left hand, in the same way as step one above, in a clockwise manner, with the flat of the fingers

Fifth, in this standing position, examine the left breast with the right hand, in the same way

Also, please note these few points when you do a self examination:

Its important that you remember the symptoms and then look for then while doing self examination. If you do not remember, you will miss out small lumps. What the mind does not know, the eyes cannot see, and the fingers cannot feel. Read the example of 'M' and 'N' on This Page. Anyone can feel the larger lumps of 4 and 5 cm or so. Its the smaller lumps, maybe around a cm or so, which we are trying to catch.

All lumps are not cancerous. In fact, in the younger age group, non cancerous lumps like fibroadenoma are more common. However, they feel similar to cancer. And we are seeing many younger patients with breast cancer. So our aim of doing a self examination is to pick up the lump and let a doctor decide what it is.

All nipple discharges are not cancerous. In fact, watery, yellow, green, milky discharges are quite common and are not cancerous at all! Only when there is blood, or a blood stained discharge, the chances of a cancer come up.

If you feel there is some abnormal symptom or some lump or some discharge, during self examination, especially which was not there before, and has come up now, you must visit your doctor.

The first time you do a self exmaination, you will feel lumpy everywhere. Slowly, over a few months or a year, your fingers start becoming aware of the density of the tissue of your breast. You will remember, that, just for example, there is some firm nodular tissue on outer side, or some softer tissue in inner side. Density of breast varies from women to women. Only after repeated exmaination, does your brain get tuned to your hands, (meaning, the brain understands what your hand is feeling), you will know what is normal for you, and then you are in a position to pick up anything new in the breast which has recently developed. So our moral is - #teach your brain #train your hands

Step Two: Perform a Breast Self Examination every month

Step 3: Clinical Examination once a year or two

If you find something on a Breast Self Examination, you will very much be consulting your doctor or a breast specialist preferably. But in addition, even if there is no finding, after the age of 40 years, it is preferable that you visit your breast specialist doctor for a check up by the doctor. A doctor trained in breast diseases is more likely to pick up smaller lumps by virtue of experience and feel. You can visit your doctor in a year or two. A point to note here, it is essential to land up with the right doctor; doctors who are not trained in breast diseases, might not be able to pick up lumps unless big, or might not be able to differentiate where to act and where not to. So, preferably, please visit a breast specialist. If you are in Mumbai, there are quite a few breast specialists. If you are not sure where to go, you can very well consult us - Dr. Sumeet Shah and we are here to help you.

Step Three: Get yourself examined by a Breast Specialist, once a year or two

Step 4: Mammography

Mammography is a special X ray of the breast in two directions (up to down, and inside to outside). In addition to the X ray, an ultrasound is also done, to add to the findings and for seeing the breast tissue in detail. Mammography can pick up very small lumps which cannot be felt by hand, it can pick up some pre cancerous situations, where a cancerous lump has not yet even formed. The sensitivity of mammography in younger women, is much lesser, due to dense breast tissue. hence, for regular screening, mammography is advised only after crossing 40 years of age.
There is some radiation involved in mammography, but with newer machines and techniques, the exposure to radiation is much less. Besides, the benefits of mammography, are far far greater than the minimal risk it may have, due to radiation. Also, mammography is a contentious issue amongst doctors. Some support it, some don't. Some trials show benefit, some don't. However, the standard guidelines by major bodies, all recommend mammography once a year, above 40 years of age. As for me, I do support doing mammography.
After the mammography is done, it is essential that you consult a doctor with the report. Mammography will pick up non cancerous situations like cysts, fibroadenomas, papillomas, etc which are non cancerous. hence, please do not Google and take decisions yourself, but please visit a good doctor for an opinion.

Step Four: Get a Mammography done, once a year or eighteen months

So these are the four steps you have to keep in mind. Just remember the symptoms, do a self examination regularly, and visit a doc once in a while. Life is just so simple. If any doubts, you can reach out to us.