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Being breast aware in your twenties

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Around 1 in 8 women in the U.K are diagnosed with breast cancer during their lifetime.

I had a breast biopsy a week and a half ago, and now I’m waiting for results. You see I’ve had a 1cm hard lump in my left breast for about two years. It hurts at times, is hard and doesn’t move. No, it’s not the C-word (cancer), but the results and my breast health are important despite this. So is yours.

Everyone with breasts can develop lumps, benign or not, throughout their life and it doesn’t matter if you are cis, trans or non-binary, you need to keep your breast health in check.

Starting this at an early age will get you into a routine that ensures throughout your life that your breasts will be healthy, as any complications or problems can be noticed early and checked out. It's right in front of you and isn’t going anywhere so it shouldn’t be troublesome to have a look.

What I have is called a fibroadenoma. When we hear medical names like that we get concerned, assuming it is something scarier than it actually is. In reality, a fibroadenoma is a type of benign breast lump that develops most often in puberty, so it appears most commonly in young people with breasts during their teens to twenties.

I had a biopsy to discover what type of fibroadenoma lump I have. If it’s a simple fibroadenoma then it won’t grow and will likely shrink during menopause, however, if it’s a complex fibroadenoma then things are different. I will need it taken out as it would keep growing and cause complications, though not ones related to cancer.  

How to be breast aware

Checking your chest is easy to do once you know how!

If you are having constant pain or discomfort in your breast that doesn’t just occur around menstruation (most fibroadenoma lumps will only hurt around points in your cycle, if at all) then take a note of it. Remember, however, that cancerous lumps in the breast are often painless and hard. 

Checking your breast regularly doesn’t have to be done like clockwork, however, it is still important to do so at some point. Breast Cancer Care and Cancer Research UK both recommend that you check your breasts occasionally to see if there are any changes, but advise that as long as you do this it doesn't matter how often you check. As long as it suits you and you’re comfortable with it. Of course, when checking your breasts it is important to check all parts, as well as your armpits and up to your collarbone.

While NHS Lanarkshire and some other bodies suggest monthly checks, there is slowly growing evidence that being too thorough might make you receive treatments you don’t need and cause un-needed worry. Over the last decades, professionals have begun to turn from rigid breast examinations to a call for people with breasts to have breast awareness. Knowing what is normal and usual for yourself is important as this can differ significantly between individuals. Having breast awareness includes knowing how your breasts normally feel and look, if there are any differences in shape and if there are any unusual rashes or lumps. Read more about the symptoms of breast cancer here.

No matter how often you decide to check, the best time to is a few days to a week after menstruation. This is because before and during menstruation many people with breasts can have lumpy, tender and painful breasts, near the armpit especially. This could be mistaken for symptoms of something sinister when it is just part of that person’s cycle. Getting a sense of how your own breasts act during the month can help act as a contrast when checking them post-menstruation when they will be soft.

Due to my gender identity, I take Depo-Provera which stops menstruation, however, prior to this I was someone who got pain and swelling. If you are someone with breasts who doesn’t experience menstruation then consult your GP about whether you should do it the same way, but, like myself, make sure to check your breasts regularly. Being aware of whether your breasts change significantly or are generally lumpy as a rule can help you pick up any differences. Breasts all look different, outside and inside. 

Once you get down to doing checks you can try it in different ways. In the shower put your left hand behind your head then use your right hand to do small circular motions on your left breast, feeling lightly and checking for anything near the surface. Then press firmly to feel for anything deeper. Continue checking around the breast, then feel above the breast up to the collarbone and out to your armpit before repeating with your left hand on your right side. After your shower, you should check your breasts in the mirror to see if there are differences in appearance. Raise your hands over your head to check for changes. Finally, try examining when lying down in the same way as in the shower. The breasts will be at their flattest in this position and consequently differences more noticeable.

The NHS Breast Screening Programme suggests differences to make note of as being a change in size, outline or the shape of your breast, a change in the look/feel of your skin, such as puckering and dimpling, new lump, thick or bumpy areas in one breast or armpit different to the same area on the opposite side, non-milky nipple discharge, nipple bleeding, a moist red area on the nipple not healing easily, any nipple position changes like it becoming pulled in or pointing differently, a rash on or around the nipple, any discomfort or pain in a breast (especially if it's new, doesn’t go away and isn’t part of your cycle).  Although, in the last case pain is often not a breast cancer symptom. Remember, if you find any lumps, nine out of ten times they are found to be non-cancerous. Despite this, if you find changes that aren’t normal for you, it's worth seeing your GP!

Your GP will examine your breasts and underarm. Most of the time it will turn out to be normal, but if they’re not sure what the cause is (even if they’re pretty sure it's normal tissue), most GPs will then refer you to a hospital or breast clinic for checks and tests. The appointments tend to be set for very soon after the GP visit, normally within three weeks, to ensure that people’s breasts are checked as fast as possible.

At one of the institutions you will likely have a breast examination by a doctor then a breast x-ray (mammogram) or an ultrasound. The most well-known test for lumps is mammograms, however, if you are in your thirties or younger and premenopausal they are quite unhelpful in comparison to an ultrasound. People with breasts who are in their 20s-30s will have denser breasts which mean that a mammogram can often miss changes. An ultrasound, like what is used for seeing a fetus’s progress in the womb, will use high-frequency sound waves instead to produce a more detailed image of these younger breasts.

Don't worry, it's painless (I’ve had two), and involves gel being spread on your breasts before the doctor or nurses uses a scanning probe to move around checking the underlying breast tissue. Under the arm is often scanned too. Sometimes both tests will be done together to provide different information, but it depends on the situation. Most of the time the professionals will then be able to tell you if its normal breast tissue or nothing of concern like a fibroadenoma. In my case, the doctor and nurse scanning me were unclear if my fibroadenoma was simple or complex, so they decided that doing an FNA or Core Biopsy and Fine Needle Aspiration was needed. Tissue was taken from my breast and now I am awaiting the results. 

The odds are extremely high that after all this you will be told the results are normal or part of a benign breast condition like my fibroadenoma, or other benign conditions like Hyperplasia, Cysts and Intraductal Papillomas. Your specialist can then explain its nature and whether any treatments or follow-ups are needed. Even if you have normal results you can continue to be breast aware and return to your GP if anything comes to light.

In the very unlikely chance (especially if you are a young person) that it is something non-benign, you will be introduced to a breast care nurse to discuss your cancer diagnosis and treatment.

No matter what, it is always important to have an awareness of our breasts, however we identify. From early adulthood we can, as young people, develop a knowledge of our own bodies’ characters which can help us have good health for years to come. 

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