Do you check your breasts?
How to check for breast cancer and what a lump feels like
According to Cancer Research, there are around 55,900 new breast cancer cases in the UK every year, which is more than 150 every day. Breast cancer is the most common cancer in the UK. Therefore, it's important you know how to check your breasts and when to get a lump checked. Even if you think it's nothing, that appointment could save your life.
What is breast cancer?
Breast cancer is the abnormal growth of breast cells, which results in the development of a tumour (cancerous breast tissue).
GP Dr Sarah Cooke explains that the most common site of cell changes occurs in cells lining the milk ducts of the breast. A smaller percentage of breast cancers affect the breast lobules (the gland that makes milk).
Ductal carcinoma in situ (DCIS) is considered the earliest form of breast cancer. This is when abnormal cells are present in the milk ducts. It is non-invasive, meaning it hasn't spread out of the milk duct to surrounding tissue. It also has a low risk of becoming invasive.
How does breast cancer develop?
Dr Cooke says there are many reasons why breast cancer develops, which include modifiable risk factors (something a person can control).
Modifiable risk factors include:
- Excessive alcohol consumption (over 14 units per week).
- Physical inactivity.
"Taking the combined contraceptive pill increases the risk of breast cancer very slightly (but it also decreases the risk of ovarian and womb cancer, so the benefits often outweigh the risks). Using hormone replacement therapy (HRT), particularly if it is a combined HRT preparation and used for longer than five years, can also increase the risk of breast cancer. The current opinion is HRT taken for five years or fewer does not significantly increase breast cancer risk," Dr Cooke adds.
As for non-modifiable risk factors of breast cancer, these are things beyond an individual's control. They include:
- Family history of breast cancer.
- Family genetic mutations (BRCA1 and BRCA2).
- Increasing age.
- Starting your periods before the age of 12, and going through menopause at a later age.
- History of previous breast cancer.
Dr Cooke explains that those who have not given birth to children have a slightly increased risk of breast cancer2.
Studies also suggest that women who are older than 30 when they give birth to their first child have a higher risk of breast cancer than women who have never given birth3. But, those who have never given birth can also have an increased risk of developing breast cancer compared with those who have children during their twenties4.
Dr Cooke explains that you can potentially reduce your risk of breast cancer by living an active lifestyle, maintaining a body mass index (BMI) between 18.5-25, and breastfeeding if you have children. The longer you breastfeed your baby, the lower the risk of breast cancer becomes. It is not fully known why this is, but there are suggestions that it's because the ovaries don't produce eggs as often while someone is breastfeeding, and the development of breast cancer is related to exposure to hormones produced by the ovaries.
What does a breast cancer lump feel like?
"A breast lump can feel different for each person. Sometimes they are 'pea-like' in size and texture; other times they may be bigger and feel hard and irregular. They can occur anywhere in the breast or in the armpit. It is important to check your breasts as well as armpits when self-examining," says Dr Cooke.
How do you check for a lump?
How to check your breasts, by Dr Cooke
- Look in the mirror at both breasts and check for new asymmetry or swelling (it is common to have one breast bigger than the other) or dimpling of the skin.
- Check for any other skin changes (like dryness or rashes) and changes to the nipples (nipple discharge, new nipple inversion, or nipple rash).
- Lift your arms above your head while in front of the mirror. Check for changes under the arms/armpits - the same as above.
- Lying down, use your right hand to palpate (pressing with various pressure) the left breast.
- Use the flat of your palm to work around the breast, starting at the collarbone, working in a circular motion (spiralling round until you reach the nipple). If your breasts are large, feeling the underneath of the breast is also important.
- Repeat on the other side.
- As above but palpating both armpits, feeling for lumps or swellings.
- Sit up and examine both breasts and armpits in the same way. Sometimes, sitting can help identify breast lumps (rather than chest wall and ribs).
Is a breast lump always noticeable?
A lump might feel different, depending on several factors, such as breast size and age (in larger breasts, lumps might be missed, for example). To the eye, the breast may look different, the contours may change, or you may notice an obvious lump or swelling. You might notice visible changes, such as fluid leaking from the nipple, rashes or redness, but could also experience breast pain, which might not have an obvious cause.
As for whether early signs of breast cancer are always visibly noticeable, some people do not even notice they have a lump, but their cancer can be detected by a screening test (mammogram) later during normal breast screening in the UK. Genetic testing for breast cancer is also available.
However, your doctor can talk you through how to self-examine your breasts - plus, there are online tutorials and graphics (like the one above) to guide you through.
How often should you check your breasts?
You should check your breasts regularly, even if you have not felt a lump in the past. Checking your breasts every two weeks, or up to once a month, helps you identify what feels normal to you and makes it easier to notice when something is out of the ordinary.
It's advised to check them on the same day each month, around a week after your period. The process shouldn't take long but be sure that you are thorough.
You can self-examine by standing in front of a mirror, but a good tip is to do it in the shower. Checking your breasts might be easier in the shower or bath, as lumps and bumps can be easier to identify when the skin is moist.
What you are looking for is a difference from last month's examination. Therefore, you should know the layout and normal feeling of your own breasts. If it helps, you could draw a diagram, so you know where any lumps or grooves already sit.
Can men get breast cancer?
While there is often a focus on how women are affected by breast cancer, men can and do get it too. In rare cases, cancer can develop in the small amount of breast tissue behind male nipples.
Breast cancer in men usually only affects those between the ages of 60-70, but there's a chance of it developing in younger men too.
The main symptom of breast cancer in male breast tissue is a lump, but the nipple might be affected too, such as a change in shape, colour, position, or discharge.
Men should also be encouraged to check for lumps and seek medical advice if anything feels out of the ordinary.
When to get a lump checked out
Dr Cooke outlines the things that might be abnormal and you should get checked out by a professional, just to be on the safe side. It might be nothing, but it's always better to get it looked at to save yourself the worry. Plus, early intervention and treatment can be key to cancer survival. Seek a review by a doctor if you have:
- A new breast lump.
- A new armpit lump.
- Nipple changes (change in nipple location, nipple inversion, nipple discharge, or skin changes around your nipple (such as eczema).
- Skin changes on the breasts (rashes or an 'eczema' appearance).
- Change in colour of the skin.
- Skin puckering or dimpling (where the skin appears 'pulled in').
"When you see a doctor regarding a breast lump or changes of concern, they will ask about your medical history and whether there is a family history of breast cancer. They will look at your medications and whether you smoke or drink alcohol (which is often on your medical record). They will ask questions about how you noticed the lump and will likely offer an examination and a referral if there is anything of concern," says Cooke.