10 minutes can save your life

With breast cancer being the emphasis on the health calendar this October, one of the big questions to ask is should women undergo the BRAC 1 and 2 gene tests?

Mr Peter Jordan, the principal officer of Fedhealth, says that in spite of the hype a couple of years ago, the BRAC 1 and 2 gene tests should only be done for high risk individuals following a full assessment and pre-test counselling.

“The tests are relatively simple and can be performed locally by various pathology laboratories. They vary in cost depending on the patient’s individual requirements and the costs are covered by most medical schemes,” he says.

Standard regular check-ups are much more important for most women.

“Preventative health is essential and we strongly advocate that women follow a regular routine of self-examination and carry out regular annual checks and mammograms,” says Mr Jordan.

He says the evidence is overwhelmingly positive, showing that where women have access to education about their own health, and where there are more effective detection and treatment programmes, breast cancer can, and is, becoming a survivable disease.

Jordan says lack of education and fear causes many women to delay seeking medical evaluation of a possible breast problem.

A thorough breast examination takes only 10 minutes, however, a surprisingly large number of women still avoid undergoing breast examinations.

Breast cancer can also occur in men, although rare, which means examinations for men are also important and this is often largely neglected.

Clinical breast examinations

The examination begins with visual inspection where the breasts are inspected for size and symmetry, a slight variation in the size of each breast is common and generally normal. The skin is then inspected for colour, vein pattern, and any visible swelling or fluid retention.

You may be asked to relax your arms at your side, raise your arms over your head, or put your hands on your hips. These movements allow the practitioner to evaluate any changes in the breast.

Most slight swelling, redness, rashes or other skin presentations are normal, but if they continue or worsen, they should be evaluated to rule out a serious breast abnormality.

Any change in the nipple, such as retraction (your nipple becoming inverted, when it was not previously) or nipple discharge, requires further evaluation.

The lymph nodes above and below the collarbone are also inspected for enlargement, swelling, discoloration or lesions.

The second part of the examination involves palpation (feeling) of the breast and underlying tissue, which is performed with the patient either seated or lying down. This is best performed a few days after menstruation, when less fluid is retained.

Light, systematic palpation includes the entire surface of the breast tissue, which stretches from collarbone to the bra line and from the breastbone to the middle of the underarm.

The examiner may choose to proceed in a clockwise direction, following imaginary concentric circles from the outer limits of the breast toward the nipple.

During palpation, the examiner notes tissue consistency, patient-reported tenderness, or masses. Finally, the areola is gently compressed to detect any discharge or secretion.

It is important to note that the vast majority of suspicious lumps turn out to be benign (not cancer). Your health care provider may request that you return to have the suspicious area rechecked in a month, or you may be advised to have a diagnostic mammogram or a breast ultrasound (sonogram) to re-evaluate the physical findings.

Many schemes have a special screening benefit which includes a mammogram paid for by the scheme and not from the member’s day-to-day benefits.

Breast self-examination

In addition to a clinical check, women must also take responsibility for their own health and check their breasts at home at least once a month. Breast self-examinations are easy and painless and can avert a serious problem later.

“Breast health education ensures that women and men across South Africa are empowered through knowledge to make choices about their health and their lives,” says Mr Jordan.

• Compiled by Caxton East and South features writer, Carmen Norton.