Mackenzie was a 19-year-old regular patient of mine. She had previously presented for usual infections and dealing with periods earlier in her adolescence, but the previous 18 months had been increasingly dominated by her anxiety as she navigated the stress of completing Year 12. She was shy, softly spoken and would often have her mother explain to me why she was presenting at any consultation. On this occassion however, she presented alone, and this was a big change.
After the usual pleasantries she blurted out “I found a lump on my breast and I am afraid of what that means”. Taking a bit more of the history, she had discovered this lump whilst in the shower a few weeks prior and in that time she was sure it had never been tender and it hadn’t changed in size. She denied any presence of nipple discharge or skin changes all of which was reassuring. “I just wanted to check it with you first before I could tell my mother. As you know, she can be a bit of a worrier, and I really don’t want her to be worried about me unless she needs to,” she said in her softly spoken voice.
Transitioning to the bed for the clinical examination, she was obviously very nervous about the whole consultation and what she thought was to come. She feared I was about to tell her she had cancer and despite her reassuring history, I was also nervous about what I was about to find. Teaching her how to do a breast self-examination I took my time to ensure she was calm about the procedure.
Step 1
LOOK at the shape and appearance of your breasts and nipples in the mirror with your hands by your sides. Raise your arms above your head and have another look. They are sisters, not twins and they do not need to look identical. Any skin changes, nipple discharge or folding/puckering when lifting arms are concerning findings.
Step 2
Laying down on the bed with your arm over your head FEEL all over your breasts and nipples, looking for anything that isn’t normal for you. Feel from your collarbone to below the bra-line, and under your armpit too in a systematic fashion so as not to miss anything.
Step 3
LEARN what’s normal for you! Breasts come in all different shapes and sizes, so get to know your ‘normal’. Try and complete your breast examination at the same time during your period cycles as hormones influence how lumpy your breasts may feel.
Having palpated Mackenzies lump, I was slightly reassured it felt like a benign lump called a fibroadenoma. For completion we organised a breast ultrasound which confirmed the great news. Weeks later she came for results, beaming at the joy of having taught her mother how to perform the breast examination on herself.
I was glad she had trusted me when she was worried and happier she was another patient who had learnt to be breast aware.
