Breast cancer – what to check for, and when to be screened

Formal monthly self-examination on a set date is no longer what is recommended, because it did not reduce deaths and it generated a lot of anxiety. What replaced it is simpler: breast awareness. Know what your breasts normally look and feel like, so that a change registers.

Breasts change with the menstrual cycle, with pregnancy, with weight and with age. Lumpiness that comes and goes with your cycle is usually normal. What matters is a change that is new, one-sided and persistent.

• A new lump or thickening in the breast or armpit that does not come and go with your cycle.
• A change in size or shape of one breast.
• Dimpling, puckering or skin that looks like orange peel.
• A nipple that has newly turned inward, or a rash or scaling on the nipple.
• Discharge from one nipple, particularly if it is blood-stained and happens without squeezing.
• Persistent pain in one spot that does not vary with your cycle.
• Redness, heat and swelling of a breast in someone who is not breastfeeding.

South Africa does not run a universal population-wide mammography programme in the way some countries do. Public sector practice centres on clinical breast examination and prompt investigation of symptoms, with mammography arranged where it is indicated.

In the private sector, regular mammography is commonly offered from around age 40, and medical aids typically cover a screening mammogram at a set interval. Ask your scheme what yours covers rather than assuming.

• A mammogram is an X-ray of the breast. It is briefly uncomfortable because the breast is compressed, and takes a few minutes.
• Younger women have denser breast tissue, which makes mammography less useful — ultrasound is often used instead.
• A strong family history, particularly a mother or sister diagnosed young, changes the recommendation and should be raised with a doctor.

It is uncommon but not rare, and it is diagnosed later in men, largely because neither they nor those around them consider it. A firm painless lump under the nipple, nipple discharge or a change in the skin needs the same investigation in a man as it does in a woman.