Breast Cancer: Symptoms, Self-Examination and Screening

Breast cancer is the most common cancer among women in Pakistan, and the country is often said to have one of the highest rates in Asia. Too many women reach a doctor late, because of fear, shyness, or the belief that a painless lump is nothing to worry about. The reassuring truth is that when breast cancer is found early, the large majority of women are cured. Knowing what to look for, and acting without delay, is the most powerful thing you can do.

Breast cancer symptoms

The most common first sign is a new lump, but there are others. Please see a doctor if you notice any of these:

• A new lump or thickening in the breast or armpit. It is often hard, with uneven edges, and frequently painless.
• A change in the size or shape of one breast
• Dimpling, puckering or an “orange-peel” look on the skin
• Redness, rash or scaling of the breast or nipple
• A nipple that turns inward, or discharge from the nipple, especially if it is bloody
• A swelling or lump in the armpit or near the collarbone
• Pain that is persistent and in one place

Most breast lumps turn out to be harmless, such as cysts or fibroadenomas, but only an examination and tests can tell. Please do not wait to see whether it goes away.

Who is at higher risk?

• Increasing age, particularly after 40
• A mother, sister or daughter with breast or ovarian cancer, and known inherited gene changes such as BRCA1 and BRCA2
• Starting periods early or reaching menopause late
• Having no children, or a first pregnancy after about 30, and not breastfeeding
• Being overweight after menopause, and little physical activity
• Regular alcohol and smoking
• Long-term use of hormone replacement therapy
• Previous breast conditions or radiation to the chest

Many women who develop breast cancer have no risk factors other than being female, so everyone should stay alert. Men can get breast cancer too, though it is rare.

How to check your breasts

Get to know how your breasts normally look and feel, and check them about once a month, a few days after your period ends. If you no longer have periods, choose a fixed date each month.

• Look in a mirror with your arms by your sides and then raised, checking for changes in shape, skin or nipples.
• Feel each breast and armpit with the flat of your three middle fingers using small circular movements, covering the whole area, both standing and lying down.
• Tell a doctor promptly about any change. You do not need to prove it is serious.

Screening: finding cancer before it shows

• A clinical breast examination by a doctor, which is a good habit from your 20s and 30s.
• Mammography, which can detect cancer before a lump can be felt. Doctors generally recommend it from about the age of 40 to 50, every one to two years, and earlier if you have a strong family history.
• For younger women with dense breasts, a breast ultrasound is often the first test.

Please ask your doctor which schedule suits you. If cancer runs in your family, ask about genetic counselling.

How is it diagnosed?

Doctors use a three-part approach: a clinical examination, imaging (mammogram or ultrasound) and a needle biopsy, where a tiny tissue sample is checked in the lab. The biopsy also shows the type of cancer and whether it is hormone receptor positive or HER2 positive, which guides treatment.

Treatment

Treatment is planned by a team of specialists and depends on the stage and type. It may include:

• Surgery: removing the lump (lumpectomy) or the whole breast (mastectomy), often with checking of the armpit lymph nodes
• Radiotherapy after surgery to destroy remaining cells
• Chemotherapy, given before or after surgery
• Hormone therapy for hormone receptor positive cancers, such as tamoxifen or aromatase inhibitors like letrozole, usually taken for several years
• Targeted therapy for HER2 positive cancers

Many women today keep their breast, return to normal life and remain well for many years. Treatment decisions should always come from your oncologist, not from home remedies, herbal cures or advice from someone who is not a specialist. Delaying proper treatment in favour of unproven remedies is one of the commonest reasons for a poor outcome.

Reducing your risk

• Keep a healthy weight and stay active, with about 150 minutes a week of exercise
• Limit or avoid alcohol and do not smoke
• Breastfeed if you can
• Eat plenty of vegetables, fruit and fibre and less fried and processed food
• Attend screening when it is due

When to see a doctor

• Any new lump, skin change or nipple change that lasts more than two weeks
• A lump that is growing, even if it does not hurt
• A family history of breast or ovarian cancer, to plan screening early

Key takeaways

• A new breast lump, skin dimpling or nipple change needs a prompt medical check, even if painless.
• Monthly self-checks, clinical examination and mammography find cancer early.
• Early breast cancer is highly curable, so do not delay out of fear or embarrassment.
• Treatment should always be guided by an oncologist.

Related medicines on Medimart

Cancer medicines are chosen and prescribed only by your oncologist. Examples of commonly used supportive and hormonal medicines:

• Letrozole: a hormone therapy for hormone receptor positive breast cancer
• Ondansetron: helps control nausea and vomiting from chemotherapy

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse cancer care medicines and supportive products on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. If you notice any change in your breast, please see a doctor promptly.