Keep the Lumps Out of Your Cups – #PinkOctober

This week ‘The Wealth of Health’ by Ubunye Healthcare features an article by Dr Natasha Di Rago. She promotes personal health responsibility with a step-by-step approach on how to perform a breast self-examination and advocates for early presentation to a healthcare practitioner.

October is dedicated to breast cancer awareness. This tragic disease, and its ever-growing incidence, has impacted the lives of women globally. The consequences of the diagnosis have led to a significant amount of suffering for women as well as their families. In an attempt to facilitate the early detection of potentially harmful breast masses I will be discussing the alarming statistics on breast cancer, the importance of screening and simple steps to a breast self-examination.

Breast cancer is a largely treatable disease when detected early, yet annually still claims the lives of over half-a-million women. It is the most commonly occurring cancer among women with more than 2 million new cases being diagnosed every year. The largest proportion of these deaths occur in developing countries, this is likely due to inadequate access to healthcare and effective screening programmes, which leads to later detection and consequently a poorer prognosis. Focusing locally, in South Africa, it is estimated that 1 in 29 women will fall victim to breast cancer. These facts highlight the importance of frequent breast self-examination to ensure women become more cognisant of changes occurring in their breasts and seek early medical advice.

A simple approach on how to correctly examine your breasts:


Routinely perform a monthly self-examination, one week after menstruation, as in the early stages of disease you may be symptom free. When experiencing changes in your breasts such as pain or heaviness, swelling, thickening and reddening of the skin, nipple changes including ulceration, discharge or new onset of nipple retraction, it is advised to seek medical attention for a thorough investigation.


Start by looking:

·  Stand in front of the mirror in an upright position with your arms relaxed at your sides.

·  Look for asymmetry in size and shape of the breast tissue and nipples.

·  Continue by looking for differences in the movement of the breast and skin whilst slowly raising your arms away from your sides to a shoulder height, then place your palms on the back of your head. This will lift the breast tissue and aids in exposing underling masses that were not previously visible.

Closely inspect the skin for:

o  Reddening

o  Swelling

o  Eczema like changes, flaking or crusting

o  Dimpling or inconsistent textures

o  An orange peel-like appearance of the skin

Now the nipples and areolar for:

o  New onset nipple inversion/retraction

o  Spontaneous nipple discharge – bloody, opaque or clear

o  Ulceration

Then feeling:

A complete breast palpation includes covering all the breast tissue, the areas surrounding the collar bone as well as under the arm.

·  This is best performed one side at a time.

·  While lying down, keep one hand behind your head and use the opposite hand to perform the breast exam.

·  Divide each breast into 4 imaginary quadrants. Start at the upper-inner quadrant.

·  Press firmly using the flat aspect of your fingers.

·  Then make small circular motions while you systematically move through each of the quadrants, in a clockwise manner.

·  Ensure you cover all the breast tissue both shallow and deep, remembering to include the nipple, areolar and the tissue below these structures.

Note that for larger breasted ladies you may need to use both hands for the lower quadrants so that you can compress the tissue against your other hand to feel for deeper masses.

·  Lower your arm and relax your hand onto your stomach. This is so that you can examine the tissue leading towards the under-arm (the axillary tail) and the underarm itself.

·  Hold the tissue from the upper-outer quadrant between your thumb and fore-fingers.

·  Use a rolling motion and follow the tissue up to where it meets the under-arm as you feel for any masses along this area.

·  Press four fingers into the deepest part of the armpit aiming at the shoulder joint.

·  Firmly compress the tissue and move along all the armpit borders to feel for any masses using the same circular motion.

Repeat these steps on the opposite side. Remember that you are feeling for changes in each breast as well as comparing differences between your breasts.

Not all masses are harmful but the evaluation of its characteristics is best left to an experienced healthcare professional. Small lumps and early cancerous changes are not easily felt therefore it is recommended to supplement a physical examination with imaging. Ultrasound is the preferred modality for females younger than 40, while mammogram is used in older women. An annual screening mammogram should be done, regardless of symptoms, in all women aged 40-54 and every 6 months for women 55 years and older. If you have a history of breast or ovarian cancer in your family then it is advised to visit your doctor yearly for a clinical exam and appropriate imaging, starting at an age of at least 10 years earlier than the age of your youngest family member at their time of diagnosis.

Breast cancer affects women of all ages and demographics and is one of many threats to women’s health. In the majority of diseases early identification and presentation leads to a higher likelihood of a successful outcome. This is the first of my attempts at empowering women with the knowledge and tools necessary to identify potential threats to their health and make informed decisions regarding their health. Learn about your body, notice any changes and take the responsibility to seek help.

written by: Dr. Natasha Di Rago 

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