Smoking increases the risk of cancer (above) and regular self examination is a must

Breasts have fascinated human beings of all ages and both sexes. It starts at birth, when the newborn infant automatically searches for the nipple and sucks hungrily. Later, teenage girls worry because their breasts are either too big or too small, asymmetrically arranged, not perfectly globular in shape, have developed too early or too late or not appeared at all.

Newborn babies of both sexes may develop enlarged breasts. This is due to the mother’s hormones reaching the baby via the placenta. It is a harmless condition which requires no treatment and subsides on its own. Infection sets it if the breast is massaged or pressed in a misguided effort to express secretions.

Breasts normally begin to develop between the ages of nine and 13. It is the first indication of approaching puberty. A pea-shaped tender swelling usually appears on one side just under the nipple. It may be uncomfortable with the girl complaining of “chest pain”. If it appears first on the left side, parents worry about heart disease. Development of the other side usually follows after six to 12 months.

Overweight adolescent boys may appear to have enlarged breasts. Actual breast enlargement owing to an increase in the glandular tissue of one or both breasts (gynecomastia) can occur in 50 per cent of adolescent boys. It may be as a result of pubertal hormonal imbalance. This is mainly a cosmetic problem and usually disappears spontaneously without treatment in six to eight months.

Gynecomastia in adult males needs investigation. It is due to a relative deficiency of the male hormone, testosterone. This may be due to liver disease, kidney failure, hyperthyroidism, as a side effect of some medication, alcoholism, or tumours of the pituitary, testes or breast itself.

Lumps appear in the breast at various stages in a woman’s life. Sometimes, the hormonal changes associated with normal menstruation will make breasts appear painful, lumpy and engorged in the 7-10 days prior to the onset of bleeding. Ninety per cent of these lumps are normal and are either fluid-filled cysts or a non-cancerous overgrowth of fibrous and glandular tissue.

Women must be aware of the normal texture of their own breasts, so that they can detect any variation sufficiently early. To do this, beginning at the age of 20 years, they should do a regular breast self examination on the same day every month.

Look at your breasts in the mirror with arms on the hips. Note the size, shape, colour and any swelling or distortion like dimpling, puckering or bulging of the skin.

Pay particular attention to the nipple area. There should be no discharge, clear, milky or blood stained. The nipple should not have changed in position, become inverted or have a rash.

Feel your breasts while lying down, using the right hand to feel the left breast and the left hand to feel the right breast. The fingers should be flat and placed together. Using a firm circular motion feel the entire breast from top to bottom and side to side. The area covered should extend from the collarbone to the top of the abdomen, and from the armpit to the cleavage.

Breast cancer is the commonest cancer in women. The risk of developing it increases with age until it is 14 per cent by the age of 90 years.

The incidence is higher in women —

Who have inherited faulty genes, particularly BRAC1, BRAC2, the ataxia-telangiectasia mutation gene, the cell-cycle checkpoint kinase 2 (CHEK-2) gene or the p53 tumour suppressor gene. They have a 10 per cent higher risk for developing breast cancer. Tests can detect the presence of these genes. However, not everyone carrying them necessarily develops cancer.

With long exposure to estrogens, as in women with early menarche (before the age of 12 years) and late menopause (after the age of 54 years).

With exposure to cancer-causing chemicals, such as the polycyclic aromatic hydrocarbons found in cigarette smoke.

Who regularly consume alcohol or are obese.

Who opt for late pregnancy or fail to breast feed.

Who go for hormone replacement therapy for more than four years after menopause.

Treatment for breast cancer has excellent results if it is detected early, even before the symptoms appear. To achieve this —

Breast self examination should be regularly performed.

A yearly breast examination should be performed by a doctor.

All women over the age of 40 years should go for a mammogram. After that, the frequency of the test depends on the doctor’s advice.

Ultrasound examination can also be done. Though it is cheaper, the results are not as reliable.

All lumps are not cancerous. Once a lump is discovered, a precise diagnosis requires a biopsy, either a fine needle aspiration (FNAC) or by removal of the lump.

Clinical exams, mammography, ultrasound examinations, cannot actually prevent breast cancer. Awareness, necessary procedures and a proactive attitude can help detect and diagnose cancer in its earliest stages, when there are more options, effective treatment and better overall prognosis.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in