Breast awareness

Your breasts

The breasts (mammary glands) are a pair of glandular organs that produce milk in response to the hormonal changes of childbirth. They're mainly made up of fatty tissue, which starts high on the front of the chest and extends down and around into the armpit. They are supported by ligaments and large muscles.

Each breast has 15 to 20 lobes with a number of lobules and ducts surrounded by fatty and supportive tissue. Each lobule has about 30 major ducts that open onto the nipple. The darker area of skin around the nipple is called the areola. At the edge of the areola there are large glands that produce fluid to lubricate the nipple.

In each armpit there are about 20 to 30 lymph nodes (glands), which drain fluid from the breast. These form part of the lymphatic system that helps the body to fight infection.

It's common and perfectly normal for one breast to be larger than the other. The nipples usually point forward, although they may look different on each breast. It's not unusual for one or both nipples to be turned inwards (inverted). This can be present from birth or can happen when the breasts are developing. The nipples themselves are hairless, but some women have a few hairs around the areola.

Between 0.4 and 6 per cent of women have an extra breast or pair of breasts, although the tissue may not look like a breast and be misdiagnosed as lymphatic or cystic. These are usually in the lower armpit and are known as accessory breasts. Some women have an extra nipple or nipples. These are usually below the breast or above the belly button on an imaginary line between the normal nipples and the groins. Accessory breasts and extra nipples aren't usually a problem and don't need to be removed.

Breast development

The breasts are constantly changing from puberty, through adolescence and the childbearing years and into the menopause, affected by changing levels in the female hormone oestrogen.

For most girls, breasts start to develop around the age of nine to 11, but it can be earlier or later. It's not unusual for the breasts to grow at different rates. Breast lumps can occur while the breasts are developing. These are always benign and don't usually need any treatment once they've been diagnosed.

Once the breasts have developed, changes linked to the monthly menstrual cycle (cyclical breast changes) are common. Just before a period, your breasts may become larger, tender or feel a bit lumpy. After a period, this lumpiness becomes less obvious or may disappear altogether (although some women may have tender, lumpy breasts all the time). Many women also experience breast pain linked to their menstrual cycle (cyclical breast pain).

During pregnancy, the breasts get much larger as the number of milk-producing cells increases. The nipples become darker and may remain that way after you've given birth, the areaolae may darken and develop small bumps too.

Around the menopause lumps are common. These often turn out to be breast cysts (benign fluid-filled sacs).

Breast tissue also changes with age. It begins to lose its firmness and the milk-producing tissue is replaced by fat, making the breasts sag. This is more noticeable after the menopause, when oestrogen levels fall. As you grow older, your breasts may change size too. If you take HRT (hormone replacement therapy) your breasts may feel firmer and sometimes quite tender.

Being breast aware

Every woman should be breast aware throughout her adult life. It's an important part of caring for your body. It means knowing how your breasts look and feel normally, so you notice any changes that might be unusual for you.

Get into the habit of looking at and feeling your breasts from time to time. There is no set way to do this. You can decide what you're comfortable with and when it's convenient for you. You don't have to look and feel at the same time.

What to look for

You need to be aware of any changes that are new or different, such as:

• A change in size - one breast may become noticeably larger or lower
• A nipple that has become inverted (pulled in) or changed its position or shape
• A rash on or around the nipple
• Discharge from one or both nipples
• Puckering or dimpling of the skin
• A swelling under your armpit or around your collarbone (where the lymph nodes are)
• A lump or thickening in your breast that feels different from the rest of the breast tissue.
• Constant pain in one part of your breast or armpit

What to do if you find a change

See your GP as soon as possible. Don't worry that you may be making an unnecessary fuss and remember most breast changes aren't cancer, even if they do need treatment or a follow-up.

When your GP examines your breasts he or she may be able to reassure you that there's nothing to worry about. If the change may be connected with your hormones, your GP may ask you to come back at a different time in your menstrual cycle. Alternatively, he or she may decide to send you to a breast clinic for a more detailed examination.

Breast Cancer Care has more information about what happens at a breast clinic and the tests used to make a diagnosis.

Breast screening

As 80 per cent of breast cancers occur in women over the age of 50, if you're between 50 and 70 you'll be invited for breast screening every three years as part of the National Breast Screening Programme.

You'll be sent an invitation to come for a mammogram (breast x-ray). This may not happen the year you turn 50, but will happen by the time you're 53. It's important to remember that you still need to be breast aware even when taking part in the screening programme. Report any changes to your GP without delay, even if you've had a recent mammogram.

A small number of women will be asked to come back for further investigations after attending a routine mammogram. This doesn't necessarily mean you have breast cancer. It's more likely to be because the mammogram is unclear, or because it shows up something that needs further tests. If you're sent a recall letter, it's important to attend the appointment.

If you're over 70, you won't be invited for screening but you are entitled to free breast screening every three years on request. Contact the breast-screening unit or ask your GP or practice nurse to arrange an appointment for you.

You can find out where your local breast-screening unit is by contacting your GP practice or visiting www.breastcancercare.org.uk.

At present, women under 50 aren't invited for screening. This is because screening hasn't yet been shown to benefit this age group.

Breast awareness five-point code

The Department of Health recommends that instead of examining your breasts every month for abnormalities, you follow this five-point code, which is much more effective at detecting changes and abnormalities.

1. Know what's normal for you

Woman of all ages should be aware of the normal appearance and texture of their breasts. The following can be normal:

• One breast bigger than the other
• Nipple inversion
• Accessory breast/nipple (two to five per cent)
• Lumpiness
• Tenderness or pain

During the menstrual cycle, some women experience enlarged, tender, lumpy breasts and these symptoms settle after the period. But some women experience lumpy, tender breasts all the time.

During pregnancy, breasts become larger as the milk-producing cells multiply. It's normal for the nipples to get darker and the blood vessels to become more prominent.

As you age, breast tissue loses its elasticity and it's normal for breasts to sag. During the menopause, your breasts may shrink (as a result of the reduction in oestrogen), although sometimes they do get larger. The nipples may alter, as the major ducts behind them get shorter and wider.

Get to know what is normal for you by:

• Feeling your breasts every day until you're familiar with their texture and how it can change through the menstrual cycle
• Look and feel your breasts regularly, whenever it's convenient for you

2. Know what changes to look and feel for

Once you're aware of what's normal for you, it's important to look out for changes in your breasts. You should look out for any of the following:

• A change in the shape of the breast (pulling of the skin, visible swelling)
• Changes in the nipple (pulling in)
• Swelling in the armpit
• Lumps or thickening that feels different from the rest of the breast

3. Look and feel

Whenever is convenient for you:

• Look at your breasts in the mirror and notice how they fall and move as you raise your arms
• Look at the position of your nipples
• Feel your breasts from time to time

4. Report any changes to your GP without delay

The majority of changes will be normal. Your GP may:

• Ask you to return at another time in your menstrual cycle
• Refer you to a breast clinic
• Invite you to attend routine screening if you're between the age of 50 and 70

5. Attend routine screening if you're 50 or over

Between breast-screening appointments, it's important that you continue to be breast aware and follow the five-point code.

Information in these breast awareness pages is reproduced with the kind permission of Breast Cancer Care.