This was going to be “Member Advice on Breast Self-Examination” but I’ve changed my mind. I can’t presume to advise you any better than http://www.breastcancercare.org.uk or
http://www.breastcancersource.com/article/11335.aspx
So, just find out how, and then do it every month! Simple!

It probably takes some kind of a scare for most people to realise how precious health is, and to demonstrate how much we take it for granted when we’ve got it. This is my experience of such a scare, and I hope it encourages at least one other woman to be “breast aware”. If only we were more like men, eh? We’d never leave them alone!

Most of us are probably guilty of subconscious “won’t happen to me” thoughts about cancer. Nothing wrong with that really, because you can’t live life worrying about what might happen, and current statistics have it that about two thirds of us will turn out to be right. All I know is, I am firmly of the opinion that the earlier you know something is wrong the better your chances of survival. My mother in law, a smoker, over sixty, refuses to go for her free NHS mammograms even though, or more probably because, she falls into the highest risk group for breast cancer. “I don’t believe in going looking for trouble” she explained to me once. Well, I am recommending you DO look for “trouble” while it’s still small enough to deal with, or else a bigger trouble may come looking for you.

I think of myself as pretty health-conscious, though I’m not super-slim, super-fit, or even super-healthy if it comes to that. But I do try to make home-cooked meals for my family; encourage the kids to eat their five portions of (very well-washed) fruit and vegetables a day; I don’t use aerosols in the house; don’t wrap fatty foods in carcinogenic clingfilm; I avoid too many processed foods, additives and E-numbers, I try to walk instead of always using the car, I go for regular smear tests. And yet…..I’m still quite blasé about breast examination. Sorry, WAS blasé about it.

Whenever the subject of breast cancer has arisen, admittedly very infrequently, we have always joked that I don’t really need to examine myself the recommended once a month, as my husband does it for me much more regularly than that anyway.
So my attitude was “won’t happen to me, it’s very rare at my age” and I did an examination properly whenever I remembered, which was probably about every three or four months.
Strange, really, thinking back because I have two friends my age (38) who are currently suffering from breast cancer. One who’s had it for 4 years (mastectomy; chemo; cancer came back in her skin over the mastectomy site; more chemo; huge operation to transplant skin from her stomach; now has cancer back in her other breast; radiotherapy etc, etc….) and another who was diagnosed two and a half years ago just after her third child, ignored the lump because she was breast-feeding and was told it was probably mastitis, and is now terminally ill with a secondary brain tumour.

I found my lump by accident almost two weeks ago whilst getting ready for bed. I leaned over bra-less and felt a pulling sensation in the outer part of my right breast. Not pain, not even discomfort, just …something not quite right, like a tightness. Even then it took me a minute to locate the thumbnail-sized thickening. They are easy to miss, you know, these breast lumps (I thought I’d got my rib when I first found it), so washing yourself in the shower, or your husband’s nightly ministrations - however good you think his technique is - just won’t do!

My first thought was – could that have been there for a couple of months without me noticing? Yes, it most definitely could have, because I couldn’t remember the last time I’d purposely searched for a lump.
My second was - I’m too young to get cancer, I wouldn’t mind so much if I was fifty or sixty and my children were grown

up. I admit this perspective may not still apply when I get to that age and I find another lump, but as I said, I have a friend with young children who has six months to live, and I cannot even begin to imagine how hard it is for her to cope with the knowledge her kids will soon lose her.

Anyway, I worried all night, went to work in the morning and asked if anyone knew of a walk-in centre for mammograms, having vaguely remembered seeing a mobile unit on a supermarket car park a few years back. I was told there was one at my local hospital, but on further enquiry found it had been closed, and un-referred mammograms were now only available to women over 50. So I called my GP and managed to get an emergency appointment for the following Monday, this now being Friday – some achievement, as all but one of the four doctors were on holiday.

Then followed one of the worst weekends of my life.
What if…. it was cancer
What if…. I had missed it for three months
What if….I had to have a mastectomy
What if….it spread
What if…. what if…. what if….
At this point the “what ifs” escalated and, well, I’m sure you can imagine the rest.

I also found myself noticing women in low-cut tops everywhere - on TV, in the paper, out and about - and wondering if this weekend would be one of the last I would be able to show a hint of cleavage. Silly, I know, because what’s losing one breast if it almost certainly prolongs your life, and probably even saves it? It did bother me though, that I had always taken them for granted, complained that they weren’t as perky and pert as pre-pregnancy days. Depends on your perspective doesn’t it? I would now be incredibly grateful to be told I was keeping both of mine.

THE GP VISIT

Not much to say about this. She’s pretty no-nonsense my GP so she had a quick feel, took a family history and said she was referring me for a mammogram. Probably noticing the signs of terror on my face she then reassured me that “most of them aren’t” and “she had a good feeling about it”. Pretty no-nonsense as I said, but also a bit too cryptic for my liking. Almost as soon as I got back home I got a phone call from the local hospital with an appointment time for my mammogram. My GP had just faxed the referral letter to them and could I come in on Tuesday next week? I have to say I was impressed! This from the NHS? Apparently current targets say that a patient in my circumstances should be seen within two weeks of referral.

THE HOSPITAL VISIT

I had by this time received an information leaflet in the post telling me what to expect from my visit. It warned that I might be there for 2 or 3 hours, so I went well armed with magazine and newspaper.
I was called in to chat to the consultant first which went on pretty much the same lines as the GP appointment.
I have no close family history of breast cancer (close meaning mother, grandmother, sisters, aunts), the lump was easy to feel, smooth and slightly mobile – all apparently good signs.
It was also 2cm – not such a good sign as the average lump found by women who perform breast examinations regularly is 1cm. “Convince me it wasn’t there last month” he said. I wished I could! Not to worry, it was probably a cyst, he said – fairly common in women my age. Only one in ten turn out to be malignant.. etc etc.

THE MAMMOGRAM.
This is a low dose X-ray used to look for changes in the breast that could signal the growth of abnormal cells. Mammograms allow the consultant to identify calcium deposits, and areas of tissue that have become distorted or denser, possibly due to the presence of an abnormal growth. They can also show whether or not lumps are solid masses (which are more likely to be a problem), or simply harmless fluid-filled cysts.
Each breast in turn is placed on the X-ray plate (very cold!) and a curved Perspex bar is lowered until the breast is squashed as flat as possible, then the radiographer retires to her cubicle (which resembles the control panel of the Enterprise) to take the X-ray.

Two x-rays are taken of each breast -wherever the lump, both breasts are done routinely both for comparison purposes, and to detect lumps in either breast which may be too small to feel. One mammogram is taken horizontally, and one vertically to ensure nothing is missed. According to the Cancer Research UK website “This can be a bit uncomfortable but shouldn’t be painful”
I would say “Yeah, right!” at this point but I don’t want to put anyone off going for a mammogram just for a few seconds of … erm… “discomfort” (Don’t the medical profession love that term?)
For the “vertical squash” you are instructed to place your arm around the machine, rather as if hugging a good friend. Yes, very similar I thought - if that friend were about to grab your breast in a vice-like grip and not let go for 20 seconds!!!!
For some reason, mine only hurt on the right breast – maybe because the radiographer knew where the lump was and possibly squashed harder. Actually, she had asked in which breast the “problem” was. I could even hear the inverted commas. I may be over-sensitive, but I didn’t like that. After all I was here because of a lump, and I was desperately hoping it WASN’T going to turn out to be a “problem”.

Another short wait for the results of the mammogram – I barely had time to complete two clues of my crossword – and I was ushered in to another consultant for a scan.

THE BREAST ULTRASOUND SCAN.

This technology uses the echoes of high frequency sound waves to create a picture of internal body structures. Ultrasound may be used together with mammography for younger women who tend to have denser breasts (more glands and less fatty tissue), since small tumors may be harder to detect in breasts that are made up of densely packed glands.
“What do I need a scan for?” I wanted to know, as I took my bra off for the third time that hour – I tell you, I was beginning to feel like a page three girl without the implants. Also with more stretch marks and less money!
“It tells us more than the mammogram, and also I’m going to do a biopsy” she replied, as I was led to an examination couch and instructed to lie down.
“A biopsy of a cyst?”
“It’s not a cyst it’s a solid lump”

Oh, right! Thanks for telling me!
Now, I know I’m being picky again, but I like to be given at least the illusion of choice in the matter. Don’t get me wrong, the doctor was very pleasant and professional, and definitely knows more than I do about what tests and treatment I need. But some prior information would have been nice. You know, something along the lines of:
“Your mammogram has shown XYZ, so we need to do a biopsy to establish exactly what the lump is”.
That would have done. I’m not asking for a synopsis of the last three years of breast cancer research, here. Just to be treated a little less like an experimental sheep herded from room to room. OK, OK, I never said I was a good patient did I?

THE BIOPSY
During a biopsy, a small sample of tissue from the lump is removed and examined. Fine needle aspiration is an alternative similar method which uses a small needle to remove a few cells of the lump. Either procedure may be done “awake” or surgically under anesthetic, depending on the size and location of the lump. Cells that are removed by either biopsy or aspiration are examined microscopically in the lab to assess whether they are benign or malignant. If cancer is detected, or if the cells are questionable, further tests will be conducted to determine the type of cancer and which procedures and treatments would work best.

Briefly, she did a quick scan with the ultrasound wand to locate the lump. Put a local anaesthetic into the skin under my armpit and performed an ultrasound-guided biopsy, which incredibly enough, sounds like a louder version of having your ears pierced but with absolutely no pain.
“Breast tissue has no pain sensors”, I was informed, when I expressed surprise.
“I wish you’d told it that when I was having the mammogram” I replied
That was pressure sensors, apparently. Silly me, not being able to tell the difference!

Bra on, back to the waiting room, in to the consultant again.
Aha, now’s my chance to ask all those burning questions.
Sorry, no! They don’t want to tell you much until it’s all in black and white. Okay, I understand that, otherwise there wouldn’t be much point doing the biopsy, if they could already tell for certain. “The signs are good” though – another cryptic utterance, which I presume means they didn’t see anything that gave much cause for concern.

So, as I sit here writing this today, I know there is a small chance I could still be that one in ten.
Pretty high odds really, when you consider. Higher than the odds of winning £10 in the National Lottery, anyway.
I just bring that up because I actually did win £10 last month for only the third time ever. Hope that’s not a bad omen. I’ll let you know.

UPDATE- THE DIAGNOSIS
I’m incredibly relieved to report that my lump has turned out to be a fibroadenoma - a benign (non-cancerous) solid lump of tissue. Apparently they are most commonly found in teenage girls and young women due to hormonal changes and breast development, but can occur in women of any age, in my case probably because I have an existing hormone imbalance.
Fibroadenomas are thought to result from increased sensitivity to the female hormone oestrogen. They normally have a rubbery texture, are smooth to the touch and are sometimes referred to as a 'breast mouse' as they move around easily under the skin, unlike breast cancer which is usually fixed. They may be painless, slightly tender or even painful.
The majority stay the same size. Some get smaller and some will eventually disappear over time, especially after menopause. A small number get bigger during pregnancy and breastfeeding. Most will stop growing after they are 2-3 cm in size.

The medical consensus seems to be that simple benign fibroadenomas and breast cysts are not considered to be pre-malignant (having the potential to become malignant) and are not associated with any increased risk of developing breast cancer elsewhere in the breast, compared to a woman without a fibroadenoma.

However, women with complex fibroadenomas have a slightly increased risk of cancer. Complex fibroadenomas are diagnosed by their appearance on mammography, ultrasound and biopsy and are associated with cysts, calcifications and other changes.

There is some research to suggest that a diet high in fat can predispose to fibroadenomas, and I have researched alternative treatments which include a low-fat, high-fibre, vegetarian-type diet; together with a reduction in caffeine intake, supplementation with evening primrose oil or fish oil, and vitamins E and C. Massaging the breasts with oil is recommended both to help fibroadenomas reduce and dissipate, as well as keep you in touch with changes in breast tissue.

The good news about being diagnosed with fibroadenoma of the breast is that it is a non-cancerous (benign) condition. The bad news (if anything can be considered bad news by comparison!) is that the lump can become painful, grow and cause deformity of the breast, or may even mask the presence of other lumps in the breast that might turn out to be cancerous.

I have decided against surgery and been discharged from the breast clinic. But it is still incredibly important to be aware of any changes and I must do regular self-examination to look for any difference including size and sensation of the lump, and to find any new lumps. I can still decide to get the lump removed in a simple out-patient operation if it grows at all or I become concerned in any way.

I am determined to examine my breasts every month because I don’t want to experience that kind of regret again, “If only I had done ....”.
At least then I'll be doing everything I can - I owe it to myself and my family.