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When doing a breast self-exam, a good way to do them is to do it systematically.

The correct time interval between breast self-exams is once per menstrual cycle. If you check your breasts at the same time each period, then the effects of the differing levels of oestrogens and progesterone during the menstrual cycle can be ignored. For post-menopausal women, once a month is a good interval.

First of all, stand in front of a mirror and remove all articles of clothing above the waist. Face square on to the mirror, with your arms by your side. Have a good look at your breasts. Ensure that they are the same shape that you're used to and that there are no new bumps or dimples in the skin.

Now, raise your arms straight above your head. By pulling your breasts upwards, you are stretching the skin over your breasts and this makes observation of any abnormality just beneath the skin more visible. Examine closely again for dimples, redness and anything that may be abnormal. Also look at your nipples and areolae and ensure that nothing's changed since the last time you examined them.

Having finished observation, go on to palpation. It is good practice to go in a set manner from quadrant to quadrant in your breasts. The following order is recommended:
medial upper quadrant --> medial lower quadrant --> lateral lower quadrant --> lateral upper quadrant

When palpating, feel with the palm of your hand, rather than with the tips of the fingers. Make sure you go over every part of your breast, pressing your breast tissue against your chest wall to feel for any lumps. After having done this once, repeat the process with your hand on your hip and pressing into your hip - this tenses up the anterior chest wall muscles and makes detection of a lump easier.

Remember to check along the "axillary tail" of the breast which is in the upper outer quadrant towards the shoulder and also around and underneath the nipple too.

It is reported that feeling for lumps is actually easier while showering - somehow the soapy water makes lumps more palpable.

The statistics show about 1 in 11 women will develop breast cancer sometime in their life, so it's a good idea to be educated and, if you have it, to have it treated early.

Note that breast self examinations are not recommended as the only method of early breast cancer detection. Please consult with your family doctor for further information.

If you do find a lump, do not panic. There is a good chance that the lump is benign. Go and visit your local or family doctor for a professional opinion.

updated - February 26th, 2002.

A study published in the Canadian Medical Association Journal and released yesterday has raised a storm of controversy. The report, conducted under the auspices of the Canadian Task Force on Preventive Health Care (funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada), acknowledges that breast cancer is a significant health concern for women, affecting some 20,000 Canadian women each year, 5,500 of whom will die. It is the most frequently diagnosed cancer among Canadian women.

However, the study found that several large trials did not show a benefit in performing routine breast self-examination (BSE), while "there is good evidence of harm from BSE instruction". Yesterday's newspapers featured this story prominently: "Breast self-examination of no use, doctors declare", blared the front page of the Globe and Mail; "Breast exams cause 'harm': study", trumpeted the National Post; and the Toronto Star chimed in with "Stop 'useless' self-exams on breasts, women urged".

Naturally, women in Canada were shocked and dismayed. Many had religiously performed BSE every month, and now they were being told it was useless. Worse than useless: harmful. But how could it be harmful?

I, being a confirmed skeptic, particularly where the news media is concerned, looked up the original article that fomented this frenzy. It turns out that the study's primary definition of "harm" was: "significant increases in the number of physician visits for the evaluation of benign breast lesions and significantly higher rates of benign biopsy results." The study also mentions that biopsies cause "permanent scarring and may cause significant breast deformity and emotional distress".

This definition of harm struck me as very odd indeed. First off, it's based on economics. The harm is that our health system has to respond to people's - especially women's - health concerns. The message is clear: don't "waste" the doctor's time with your worries about this major killer of women. It's a sad day for Canada when dollars are more important than health.

And another thing: isn't a benign biopsy far preferable to breast cancer and potential death? What's so harmful about a benign biopsy? I'd rather have a scarred breast than no breast at all. I'd choose deformity over death any day.

Finally, and most tellingly, the study is silent on the fact that biopsies require a doctor's intervention: it's not like women do BSE, discover a lump, and head off to the nearest hospital. Oh no! They go to their doctors, who examine the lesion and decide what to do. Seems to me it's the doctors who should be better trained to interpret the natural lumps that occur in women's breasts. Surely it's the doctors, not the women themselves, who are responsible for all the "unnecessary" biopsies. But the study doesn't mention this. I was flabbergasted at this obfuscatory logic that lay behind the report's recommendations. It's blaming - I want to say terrorizing - the victims, while leaving their accomplices unscathed.

Many women came forward to say that they believed that they were alive today because of their own early detection of cancerous tissue. My own mother's breast cancer was too far advanced, when diagnosed, for adequate treatment; she lost her breast, and then her life, to this disease, with several years of pain and anguish in between.

So what, then, should be the message here? Ignore your body, women? Trust your doctor? I think not. Be aware of your body (many lumps are found during clothing, bathing or sexual relations). If you choose to do BSE, be sure you're doing it correctly; if not, do what I do (for it's too stressful for me to manage) and go see your doctor every 6 months for a clinical exam. And, as much as you can, be sure your doctor knows what they're doing. It's your life, not theirs.

Read the CMAJ article I refer to at

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