Breast cancer is the most common type of cancer among women. It happens when the normal cells in the breast change and multiply uncontrollably. It is much more common in women, but rarely males too can develop this condition. Breast cancer sometimes runs in the family.
The most common initial symptom of breast cancer is a non-tender lump in one of the breasts.
Breast cancer can occur at any age, though it is most common in women older than 50. Lumps or changes also may be signs of other breast conditions, such as mastitis or a fibroadenoma.
If you feel a lump in your breast see your doctor or nurse immediately. Breast lumps can be caused by conditions that are not cancerous. But it is a good idea to have any lumps checked out.
Normal Breast 
Learning how your breasts feel at different times and becoming familiar with their appearance will help you to know what is normal for you.
Before Menopause
Before the menopause normal breasts feel different at different times of the menstrual cycle. Milk-producing tissue in the breast becomes active in the days before the menstrual period. In some women the breasts at this time feel tender and lumpy, especially near the armpits.
After Menopause
After the menopause, activities of milk-producing tissues stop. Normal breasts feel soft, less firm and not lumpy.
Breast self-examination
A breast self-examination involves checking your breasts for lumps or changes. Since Sri Lanka does not provide routine breast cancer screenings like most developed countries do, breast self-examination is important for early detection of cancer.
Breast self-examination should be conducted once a month by all women starting from 20 years of age.
Many breast problems are first discovered by women themselves, often by chance. Breast lumps can be non-cancerous (benign) or cancerous (malignant).
How do you perform a breast self-examination?
The best time to examine your breasts is usually 1 week after your menstrual period starts, when your breasts are least likely to be swollen or tender. If you are not menstruating, a fixed date should be selected.
Breast self-examination has two components:
1. Inspection (Preferably in standing position)
2. Palpation (Either lying down, sitting, standing or while bathing):
Inspection
Stand in front of the mirror exposing the chest up to the waist, look at the breasts through the mirror, while keeping the arms
1. Arms hanging by the side,
2. Hands pressed on the hips,
3. Arms raised over the head
Palpation
Remove all your clothes above the waist. Lie down. Lying down spreading your breasts evenly over your chest makes it easier to feel lumps or changes. Check your entire breast by feeling all of the tissue from the collarbone to the bottom of the bra line and from the armpit to the breastbone.
Use the pads of your three middle fingers—not your fingertips. Use the middle fingers of your left hand to check your right breast. Use the middle fingers of your right hand to check your left breast. You can use an up-and-down pattern or a spiral pattern. Move your fingers slowly in small coin-sized circles.
Use three different levels of pressure to feel all of your breast tissue. Light pressure is needed to feel the tissue close to the skin surface. Medium pressure is used to feel a little deeper, and firm pressure is used to feel your tissue close to your breastbone and ribs. Avoid lifting your fingers away from the skin as you feel for lumps, unusual thicknesses, or changes of any kind. Find out whether there is a nipple discharge by squeezing the areola using thumb and middle finger.
When in doubt about a particular lump, check your other breast. If you find the same kind of lump in the same area on the other breast, both breasts are probably normal.
Changes to look for
Appearance-, Look for changes in colour, skin changes, asymmetry, changes in the outline or shape of the breast especially those caused by arm movements or by lifting the breasts, any puckering or dimpling of the skin.
Feelings - Discomfort or pain in one breast that is different from normal, particularly if new and persistent.
Lumps - Any lumps, thickening or bumpy areas in one breast or armpit which seem to be different from the same part of the other breast and armpit. This is very important if new.
Nipple change
- Nipple discharge, which is new for you and not milky.
- Bleeding or moist reddish areas which don’t heal easily.
- Any changes in nipple position – pulled in or pointing differently.
- A nipple rash on or around the nipple.
What to do if you observe a change?
There can be many reasons for changes in the breast. Most of them are harmless, but all of them need to be checked as there is a small chance that they could be the first sign of cancer. If you are aware of any change in your breasts from what is normal for you, tell your doctor without delay. Remember, you are not wasting anyone’s time. If there is a cancer present, the sooner it is reported, the simpler treatment is likely to be. This offers greater prospects of benefit in terms of quality of life.
