General care

There has been some recent controversy on the efficacy and necessity of breast self-examination. Whatever the statistical evidence eventually shows, I am of the firm opinion that care and attention paid to the breasts makes a substantial difference to their well-being. I am not a great supporter of the mammogram and I have therefore encouraged self-examination throughout my career and many lumps have been found and dealt with, including cancers, which, when caught early, can mean the difference between health and illness.

The breasts are very much under the influence of the female hormones and there are nervous and hormonal reflexes associated with touching the breasts that may contribute to keeping them healthy. Love and attention from both the individual and partners may have a profound effect.


Self-examination should be performed on a regular daily basis.

In the bath or shower imagine a line drawn from the middle of the collar bone down through the nipple to the lower rib and another line bisecting this perpendicularly across the chest at the level of the nipple. We have now imaginarily divided the breast into four quadrants. There is a fifth section that requires attention called the ‘wing’. This is the section from the upper outer quadrant stretching back to the armpit or axilla.

Using the palm of the hand in a rotating motion examine the left breast with the right hand, and vice versa. Place the palm in the middle of each quadrant initially but move the palm so that it covers the entire area. Repeat this in all four quadrants. Lumps are very noticeable in the palm of the hand and cannot slip between the gaps in between fingers. The same should be done with the wing of the breast, although fingers must come into play nearer the armpit. Special attention should be paid after this initial examination to the nipple and areola. Gentle palpation with the fingertips all around and directly below the nipple is recommended.

All breasts have lumps. Examining the breast daily will allow the individual to get an idea where these lumps are and whether they change at different times of the cycle.

Breast tissue is very often granular, either generally or at particular times of the cycle when the breast is most under oestrogen effect . Establishing a knowledge of what your breasts feel like will remove the likelihood of your missing an unusual textured lump or of worrying unnecessarily. I encourage partners to examine the breasts regularly to offer a second opinion. The use of doctors and gynaecologists is essential but should not be considered a completely safe option. Whilst doctors may have more experience, a yearly all-clear does not take into account the lump that develops two months after the examination. A clear examination is not complete security for the year.

Remember that most lumps are harmless and that bringing a lump to the attention of the doctor does not usually return a verdict of cancer. Developing the ‘ostrich syndrome’ by burying your head in the sand and ignoring a possible cancer can lead to a poor outcome. Breast cancer, if caught early enough, is treatable and curable.

Self-examination should be done daily.

Note lumps and bumps mentally or keep a note if necessary and compare at different times of the month.

Bring any hard or persistent lump to the attention of your GP.

Bring any nipple changes or breast shape changes to a doctor’s attention.

Cancer lumps generally do not alter on a cyclical basis, although the tissue around them may. A lump that comes and goes is not likely to be dangerous. Do not worry, but get it checked.