Being 'aware'

For years women were advised to examine their breasts once a month. Now the message has changed. These days women are encouraged to Be Breast Aware.

The change of tack came in 1991 after the government's chief medical officer confirmed that breast self-examination had no impact on breast cancer mortality. In addition, a major study set up by the NHS Breast Screening Programme revealed that although over 80 per cent of women knew about breast self-examination, only three per cent did it - and many felt guilty about not doing it, or not doing it properly.

As a result, the concept of breast awareness was introduced instead. Dr Joan Austoker, of the Cancer Research Campaign, who co-ordinated the study on behalf of the NHS Breast Screening Programme, explained what is meant by breast aware.

"Over 90 per cent of cancers are found by women, so it is important to optimise both the chances of finding the cancer and prompt reporting of any change.

"Our research showed us that women should be focusing on breast awareness as part of general body awareness. The idea is to encourage women to become familiar with their normal breasts at different times of the month and to report any changes promptly.

"To be breast aware you do not have to be taught a set technique or do it at any specific time. Breast self examination, by contrast, is a formal, ritualised technique following a set procedure which is often taught to the woman and is meant to be done at a specific time.

"Breast awareness concentrates on what is normal for you and what changes to look for and report. Breast self-examination concentrated on the abnormal, which meant that your potential reward for doing it right was to find something terrible."

Some professionals still advocate breast self-examination and there is no reason why a woman who is happy to carry out this routine should not do so. However, for the majority, breast awareness is a much simpler option.

A woman should become familiar with her breast tissue by looking and feeling in a way that is best for her. Breast awareness then becomes part of everyday life.

The aim is to understand how breasts feel different at different times. Then, if she detects any change, she can discuss it with her doctor.

Before menopause, the milk-producing tissue in the breasts becomes active in the days before a period. In some women, the breasts feel tender and lumpy at this time, especially near the armpits.

After a hysterectomy the breasts usually show the same monthly differences until the time when a woman's periods would have stopped naturally. Activity in the milk-producing tissue stops after the menopause. Normal breasts then feel soft, less firm and not lumpy.

There can be many reasons for changes in the breast and while most are harmless, all need to be checked as there is a chance they could be the first sign of cancer. If there is cancer, the sooner it is reported, the more simple the treatment and the better the long-term prospects.

Mammograms can detect cancer before it is felt and it is important for women over 50 to use the NHS breast-screening programme. However, mammograms are not foolproof, so older women must remain breast aware.

Breast Awareness is based on a five-point code:

know what is normal for you

look and feel

know what changes to look for

report any changes without delay

attend for breast screening if aged 50 for over

Changes to look out for:

Appearance:

Any change in outline or shape of breast, especially those caused by arm movements or by lifting the breast

Any puckering or dimpling of the skin

Feelings:

Discomfort or pain in one breast that is different from normal, particularly if new and persistent

Lumps:

Any lumps, thickening or bumpy areas in one breast or armpit which seem to be different from the same part of the other breast and armpit. This is very important if new

Nipple change:

Nipple discharge, new for you and not milky

Bleeding or moist reddish areas which don't heal easily

Any change in nipple position - pulled in or pointing differently

A rash on or around the nipple