Trinidad and Tobago Guardian - Breast Cancer Awareness Month Supplement

Tuesday, October 26, 2021 guardian.co.tt

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Tuesday, October 26, 2021 guardian.co.tt

Tuesday, October 26, 2021 guardian.co.tt

BREAST CANCER IN TRINIDAD & TOBAGO PROFESSOR VIJAY NARAYNSINGH Professor Emeritus of Surgery, UWI Consultant Surgeon, Medical Associates Hospital

B

reast cancer is the commonest cause of death from cancer in Trinidad and Tobago.

In addition, the diagnosis and treatment have major physical, psychological, social, domestic and economic implications. A woman may lose her breast or part of it, have chemo and radiotherapy and have to live through significant alterations in body image associated with breast asymmetry, skin scarring, nail discolouration, hair loss and the psychological sequelae of these and other factors.

Many women become social recluses and limit their previous normal recreational activities.

These implications are more significant in the younger patients. Unfortunately, in T&T, 34% of breast cancers are seen in the under 50 age group.

Thus, apart from the adverse implications mentioned above, the effect on their young children, spousal and family relations, employment and finances can be very serious.

In addition to diagnosis under age 50, about one-third of deaths from breast cancer occur in this age group.

In spite of advances in treatment, there is also an increasing mortality from breast cancer in T&T. While mortality has been decreasing in the developed world (for example, USA, UK, Canada) it is increasing here.

Although genetic factors may play a small part, limitation in early diagnosis and prompt appropriate treatment may be more significant although there is no hard data to establish this.

A major problem here is an overemphasis on mammography. There is much data and sharing significant limitations of mammography especially in the developing world.

In T&T, as many as 20% of women with breast cancer have negative mammograms. Although this may be explained by the large number of younger patients, other factors may be involved.

Data from our National Cancer Registry also document a disproportionate preponderance of the disease among blacks.

Data from the USA and other Caribbean terri-

tories suggest that this is likely to be genetic. It is important for women to recognise that breast cancer is painless in over 90% of cases.

Thus, a painless lump could be very significant and should be assessed by a professional, not just a mammogram.

It is also known that the bra is likely to leave a more marked skin impression on the side with breast cancer (bra sign) – so if this is observed, expert help should be sought.

Skin tethering, nipple retraction, alteration in skin appearance and texture, ulceration, axillary mass (under the armpit) are generally later signs and it is hoped that diagnosis will be made before these findings.

Diagnosis involves clinical examination, imaging (Ultrasound, mammogram, CT, MRI) and biopsy. Confirmation by microscopy is essential for diagnosis, planning treatment and assessing prognosis.

Although surgery is an essential part of treatment, chemo, radio and hormone therapy are major determinants of long term recurrence and survival; thus, follow-up treatment, though tedious and time consuming, is essential.

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Tuesday, October 26, 2021 guardian.co.tt

The Vax Scene

COVID-19 vaccine insights for you and your family

Pregnancy and the COVID-19 vaccine “We know that if pregnant women get sick, they have a higher risk of developing serious COVID symptoms, and more frequently require ventilation and intensive care, when compared to women who aren’t pregnant.

They also have a higher chance of delivering their baby early or pre-maturely.”

--Carissa F Etienne, PAHO/WHO Director The connection between a mother and a child is like no other.

It is spiritual; as deep as the ocean, yet tender as the dawn of a new day.

In the midst of a pandemic, the act of bringing a child into the world is one of defiance, a declaration that we will determine our future.

However, after two years of living through the pandemic, health care professionals are warning that pregnant women are at a greater risk of becoming infected by COVID-19.

Why are they more vulnerable?

Medically, it has to do with another connection between mother and baby, the placenta. The placenta is located in the uterus or womb and is a vital link for oxygen and nutrients from the mother to the foetus. Doctors caution that a “viral infection can disrupt the placenta’s function, leading to preterm birth

and, in the worst case, the death of the foetus in the womb.”

Mother knows best For decades, pregnant mothers in Trinidad and Tobago have safely received vaccines such as for the flu or whooping cough, without harming the protective nature of the placenta.

The COVID-19 vaccine operates in a similar way to these more familiar vaccines.

If you are pregnant or thinking of becoming pregnant, it is essential to stay healthy and informed. For instance, the COVID-19 vaccine has proved to be safe for mothers who are breastfeeding. Additionally, researchers have found that if a mother develops antibodies to the virus, these will be passed to the baby through breast milk.

Unfortunately, the increase in pregnant women becoming infected by the coronavirus has been described by local health officials as alarming.

The presence of the more infectious Delta variant makes vaccination for pregnant women even more urgent.

In difficult times, a baby symbolises hope, opening us to the possibilities of the future. As parents, let us offer a similar promise to our unborn child.

Vaccinate today....live tomorrow!

Did you know?

Only the Pfizer-BioNTech vaccine is recommended for pregnant women at this time, and only for women in their 2nd or 3rd trimester You cannot catch COVID-19 from

the vaccine nor can you pass an infection to your baby through your breast milk.

In the last trimester the risk of the baby being born prematurely or dying increases.

Tuesday, October 26, 2021 guardian.co.tt

EARLY DIAGNOSIS SAVES LIVES B reast cancer is the most frequent malignant tumour among the population and the most common in the female population.

Every year, more than 2.2 million new cases are diagnosed, and at least 684,000 patients die from this cause around the world.

In Trinidad and Tobago, breast cancer is also the most common in women: 574 new cases and 257 deaths, according to Globocan statistics for 2020—the most recent available.

In commemoration of Breast Cancer Awareness Month, Roche Pharmaceuticals reiterates the importance of early detection and diagnosis as the most important tool to fight this disease. The earlier it is detected, the greater the chances of survival for the patient.

“Paying attention to any alteration in the breasts is recommended. This includes tenderness on palpation, nipple discharge, changes in skin colour or texture and/or lumpy masses, hardening or sagging of breasts, nipples and/or armpits.

“Breast self-examination allows getting to know breasts and identifying any changes.

However, a mammogram is the diagnostic method par excellence and it must be performed annually from the age of 45,” explained Dr Naresh Nandram, MD, Medical Ecosystem Partner for Roche Trinidad and Tobago.

In terms of risk factors for breast cancer, the main one is being a woman; followed by

abnormal cells in the milk-producing glands of the breast or in the ducts that carry milk to the nipples.

“The type of breast cancer will be defined by the presence or absence of three receptors found on the surface of cells: the estrogen receptor (ER), the progesterone receptor (PR) and the growth factor receptor 2 (HER2).”

This disease is classified into three large groups or subtypes, as shown.

Below, the details: HORMONE RECEPTOR POSITIVE:

Dr Naresh Nandram age, family history, having had breast cancer, women who have not had children or those who have them from the age of 40, obesity, oral contraceptives, environmental pollution, hormone replacement therapy, alcohol, among others.

What are the types of breast cancer?

Breast cancer is not a single disease and knowing the biological and genetic aspects of the cancer cells that cause it (proteins or receptors) is important in order to provide the best treatment to each patient and increase their life prognosis.

According to Dr Nandram, breast cancer is characterised by the uncontrolled growth of

It accounts for 62% of breast cancer cases. This malignant tumor grows in response to oestrogen and progesterone hormones. Thus, their chances of responding to treatments aimed at inhibiting hormone growth effects are good.

HER2-POSITIVE: It is an aggressive type of cancer which responds to treatments specifically targeting the protein known as HER2. This type of cancer occurs in 18% of cases.

TRIPLE NEGATIVE: It is characterised by the presence of cancer cells that do not express oestrogen, progesterone or HER2 receptors. It is an aggressive and difficult to treat type of cancer, as it generally does not respond to standard treatments. It accounts for about 20% of this disease.

“Currently, treatments for this disease are increasingly targeted and respond according to the molecular information of the tumour. Thanks to these advances, about 85% of women survive the disease five years after being diagnosed”, mentioned Dr Nandram.

Early diagnosis is key In Latin America, between 30% - 40% of breast cancer cases are diagnosed at an advanced stage, complicating health conditions and life expectancy.

- Understanding the nature of the tumour allows for the designing of a targeted and effective treatment plan.

- As a result of an early diagnosis coupled with Medicine advances, this disease is no longer considered as synonymous with death.

“It is essential that the popula-

tion knows the risk factors and signs and when there is suspicion, visit their healthcare provider to be screened and get a diagnosis as early as possible.

“Unfortunately, in the country such early-stage diagnosis is one of the main challenges in terms of breast cancer. Thus, we must unite so that there is greater knowledge and awareness about the importance of a life-saving, timely diagnosis,” concluded Dr Nandram.

Sources: Observatorio Global de Cáncer. https://gco.iarc.fr/today/ home. Last entry: October 14, 2021.

AmericanCancerSociety. https:// www.cancer.org/es/cancer/cancerde-seno.html. Last entry: October 14, 2021.

ARTICLE SUBMITTED BY ROCHE PHARMACEUTICALS.

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Tuesday, October 26, 2021 guardian.co.tt

INNOVATION IMPROVES EARLY DETECTION I

ntroducing the world’s first app designed to imCorrine’s passion for educating people everywhere is fuelled by her grandmothers and a close prove early detection, with a twist of lemon.

Learn how you can self-exam, six ways to iden- friend who died from breast cancer.

Driven to take action against the disease, she tify the 12 symptoms of breast cancer, track your period, take a risk quiz and get a custom screening learned just about everything there is to know plan to make knowing when to get a mammoabout breast cancer detection and treatment, gram crystal clear. and studied the psychological effects of healthcare communication.

Dr Corrine Ellsworth-Beaumont After receiving her PhD in design, MFA, PhD, is the founder of the Know Corrine took the findings from Your Lemons Foundation and the her doctoral dissertation, Design designer behind Know Your Lemons, the innovative campaign thinking in healthcare: developing teaching about the symptoms of patient-centred communication materials for breast cancer detecbreast cancer and the process for tion, and created the Know Your detection.

Lemons® Foundation.

Her groundbreaking work is creDr Corrine Ellsworth-Beaumont ating a new paradigm of healthcare shares: “My wish is to make it easy for communication and has been viewed everyone to change the picture of breast by one billion people worldwide. Because cancer with me, and save the lives of the familiar, friendly lemon crosses comDr Corrine mon healthcare communication barriers our grandmothers, mothers, sisters and Ellsworth-Beaumont of literacy, taboo and fear, #knowyourfriends along the way.”

Founder, Know Your lemons is the only truly global breast Lemons Foundation DOWNLOAD the app on : cancer education campaign. https://knowyourlemons.org/self-exam-app

Tuesday, October 26, 2021 guardian.co.tt

Tuesday, October 26, 2021 guardian.co.tt

Tuesday, October 26, 2021 guardian.co.tt

Tuesday, October 26, 2021 guardian.co.tt

Tuesday, October 26, 2021 guardian.co.tt

BREAST CANCER IN MEN? IS IT POSSIBLE?

“I

have WHAT kind of cancer?”

Such is the reaction that many men have to being told they have breast cancer.

Any cancer diagnosis is a shock; but finding out you have a kind you never thought you could get makes it even harder to accept.

All people, whether male or female, are born with some breast cells and tissue. Even though males do not develop milk-producing breasts, a man’s breast cells and tissue can still develop cancer.

Though, male breast cancer is very rare, it is just as serious as that which women experience.

The American Cancer Society estimates that around 2,500 new cases of breast cancer in men are reported every year, claiming the lives of 460 men.

Breast cancer in men is usually detected as a hard lump underneath the nipple and areola.

characteristics), which were used to treat prostate cancer in the past, increase men’s breast cancer risk.

KLINEFELTER SYNDROME This is a rare genetic condition in which a male has an extra X chromosome.

This can lead to the body making higher levels of oestrogen and lower levels of androgens (hormones that help develop and maintain male sex characteristics).

MEN CARRY A HIGHER MORTALITY THAN WOMEN DO, PRIMARILY BECAUSE AWARENESS AMONG MEN IS LESS AND THEY ARE LESS LIKELY TO ASSUME A LUMP IS BREAST CANCER.

Let’s check it out, instead of toughing it out!

This assumption is the main reason for the delay in seeking treatment.

What are the symptoms?

The most common symptoms of breast cancer in men are similar to women, with the majority of men being diagnosed over the age of 50: - A lump or swelling in the breast.

- Redness or flaky skin in the breast.

- Irritation or dimpling of breast skin.

- Nipple discharge.

- Pulling in of the nipple or pain in the nipple area.

What are the risk factors?

Several factors can increase a man’s chance of getting breast cancer. Having risk factors does not mean you will get breast cancer.

GETTING OLDER The risk for breast cancer increases with age. Most breast cancers are found after age 50.

OVERWEIGHT AND OBESITY Older men who are overweight or have obesity have a higher risk of getting breast cancer than men at a normal weight.

GENETIC MUTATIONS Inherited changes (mutations) in certain genes, such as BRCA1 and BRCA2, increase breast cancer risk. In men, mutations in the BRCA1 and BRCA2 genes can also increase the risk of highgrade prostate cancer, and pancreatic cancer.

LIVER DISEASE Cirrhosis (scarring) of the liver can lower androgen levels and raise oestrogen levels in men, increasing the risk of breast cancer.

FAMILY HISTORY OF BREAST CANCER A man’s risk for breast cancer is higher if a close family member has had breast cancer.

CONDITIONS THAT AFFECT THE TESTICLES Injury to, swelling in, or surgery to remove the testicles can increase breast cancer risk.

RADIATION THERAPY TREATMENT Men who had radiation therapy to the chest have a higher risk of getting breast cancer.

HORMONE THERAPY TREATMENT Drugs containing oestrogen (a hormone that helps develop and maintain female sex

For all the physical problems posed by breast cancer in men, it may be a psychological trait that makes the condition especially dangerous.

The tendency of some males to want to “tough it out,” or flat-out ignore signs of an underlying medical condition can prove deadly in the case of cancer.

In one study by Harvard Health, researchers found that men waited about 19 months to seek medical care upon discovering initial symptoms.

We can safely assume that many of the men who put off medical treatment for such a long period don’t think of their condition as particularly dangerous.

Moreover, we may assume that the very strong cultural undertone of breast cancer as a “women’s issue” contributes to this problem.

The bottom line: breast cancer is a dangerous disease and one that can spread quickly without intervention.

No matter your gender, if you notice any of the above-mentioned symptoms, seek medical attention right away. If you’re one of those “No big deal” guys, swallow your pride and schedule an appointment with your doctor.

For more information: https://www.cdc.gov/cancer/breast/ men/index.htm https://www.health.harvard.edu/blog/ breast-cancer-in-men-uncommon-butcatching-it-early-is-vital-201205254785

12 Hearing the word ‘spread’ and knowing that it was not as localised as I thought, made me prepare for the worst-case scenario. I imagined hearing the doctor say that they could not do anything for me.

Tuesday, October 26, 2021 guardian.co.tt

WARRIOR SARITA

RAMPERSAD

...creates her ‘Cancer Cheat Sheet’

Sarita Rampersad Photo by Kibwe Brathwaite

“I

decided to share my story because people need to know that you could be living your life perfectly fine and in two days everything can change.

I found a lump under my arm in mid-September 2020 and within two weeks I was diagnosed with aggressive stage three HER2 positive/ hormone negative breast cancer that spread to my lymph nodes.

Before my diagnosis, I felt perfectly healthy.

I generally tend to ignore things until they go away but when I found the lump, I knew it was not normal, so I asked my friend to make an appointment for me to see her general practitioner.

The doctor informed me that what I was experiencing might be an allergic reaction, however, to be sure, they recommended that I do an ultrasound and mammogram. I had a gut feeling when I left the office so I made the appointment to do the tests the next day and that’s when I found out that I had cancer.

I appreciate irony as much as the next person and acknowledging a lump and being diagnosed with breast cancer at 48, almost exactly

15 and 18 years after my parents died (not cancer) during breast cancer awareness month, is about as ironic as it gets.

The scans showed scattered calcifications and problems with my lymph nodes. To rule out the spread to anywhere else, the doctors had me do a full-body CT scan.

At that point, I thought I was going to die. I felt like a ticking time bomb. Hearing the word ‘spread’ and knowing that it was not as localised as I thought, made me prepare for the worst-case scenario. I imagined hearing the doctor say that they could not do anything for me.

Through those scenarios, I discovered a whole new love for living that I previously took for granted.

I thought about my seven-year-old niece and it was hard to imagine not being around to see her grow up. I told myself that this is not going to kill me, and I refused to die. A switch flipped in my brain and that is how it has been ever since.

It is not an escape mechanism or denial, I have just decided to focus on battling it through nutrition, folContinues on Page 13

Tuesday, October 26, 2021 guardian.co.tt

I have done two rounds of chemotherapy thus far. To prepare for that, I decided to cut off my hair so I would not be traumatised by the hair loss and I have also changed my diet completely. —Sarita Rampersad From Page 12

‘THE SYMPTOM I IGNORED’

Survivor Onika Thompson shares

“M

y life was totally normal, except for a pesky stain that appeared on my blouse daily. A healthy appetite, no sudden weight gain/ loss, no lumps felt…only those mysterious stains,” Onika Thompson shares.

lowing the doctors’ advice, and trusting the science.

My treatment process has been manageable, and all of the nurses and doctors are great. I have done two rounds of chemotherapy thus far. To prepare for that, I decided to cut off my hair so I would not be traumatised by the hair loss and I have also changed my diet completely. I have a friend who was diagnosed with terminal cancer five years ago and given three months to live. Chemotherapy and treatment worked for her and she’s doing well to this day.

In my family, there is a history of cancer. My mother’s sister survived hormone-positive cancer 10 years ago and on my father’s side, two of my aunts had it.

One of them has passed and the other is still alive. I intend to get genetic testing and counselling for my niece’s sake because I want her to have all the information she will need.

My friends and family have been incredible. I realised within this journey, that “Cancer is expensive.” I had to raise funds for a specific drug and they stepped up and organised a ‘GoFundMe’ and set up a bank account without me knowing because they didn’t want me to be stressed. I’m also part of various support groups and it’s incredible to have that support. The groups are a hub for people to show and ask for guidance. I try to share as well because I benefited a lot.

While dressing for work in July 2017, Onika’s son entered her room and pointed out the blood on her hands.

She looked down and saw blood dripping from her left breast. Confused and afraid, she googled. Ruling out cancer completely, she believed it was a clogged milk duct. She monitored the area herself and didn’t tell anyone.

Weeks elapsed with inconsistent bleeding but she could no longer ignore it.

The Cancer Cheat Sheet

More than a pesky stain

Underlying all of this is my personal choice to trust science but give it a little help. Everything I am sharing I’ve cleared with my oncologist and other doctors. My main goal is to kill cancer cells. Get your nutrients from ‘god foods’ as Dr Sabga says. As another doctor told me when I pleaded a case for the occasional roti and non-organic food - healthy people are at least 20 feet from the edge of the cliff. You are about three. You want to move away from, not closer to it.

I am not saying what worked for me will work for you, but these are researched tips and tricks that for some unfathomable reason, are not contained in one comprehensive, kick cancer in the butt bible. I had to search and consult and scour for some of these gems, and I truly hope that they might ease your way a bit.

In August, Onika told her husband, and visited the hospital. To determine the cause, she needed further tests which were scheduled for November.

Prompted by family, Onika decided to pursue testing privately.

Two weeks following an open biopsy, Onika was diagnosed with breast cancer. She was distraught and thought it was a death sentence. Her diagnosis was unexpected with no family history of cancer.

Onika fought through her emotions and garnered the strength to fight for herself and her loved ones, especially her three young boys. A whirlwind of trips between Tobago and Trinidad followed, with tests and surgeries done.

In the first surgery, she had one breast removed.

She remembered being very lucid after surgery and not feeling pain. The magnitude of the operation didn’t hit her until the night when she felt the tubes and missing tissue where her breast once was.

Her nurse recommended that she get counselling.

Message to other warriors Even though it feels lonely, it does not have to be.

The resources exist. You can meet people like you and get the support you need. Don’t give up. Do what you can to make yourself stronger and fight it.

My mentality is, if I get knocked down eight times, I’ll get up nine. I’m preparing myself for it to get a lot worse but I intend to stay standing at the end of it.

Submitted by Sarita Rampersad The full list of recommendations on Sarita’s Cancer Cheat Sheet can be found at https://www.facebook. com/SaritaSaysForkCancer along with a host of resources and her recent interviews. Within it are helpful suggestions to counter the side effects of Chemotherapy: Bone Pain, Mouth Sores, Metallic Mouth, Constipation, Nail Changes and so much more. In addition, more of her journey is shared here for other cancer warriors to feel supported and connect: https:// saritasaysforkcancer.com/get-in-touch/]

Her story was first featured on CCRI - Caribbean Cancer Research Initiative and she noted the need for more cancer clinics in Tobago given capacity issues. Tobagonians have the added pressure of shuttling between Tobago and Trinidad for their treatment. She also highlighted the need for more accessible cancer awareness programmes and stressed the importance of regular cancer screening since early detection means earlier treatment.

Her story

The road to recovery

Onika struggled with the transition and couldn’t bear the sight of her breast. She didn’t want anyone to see her and was concerned with how her sons and husband would perceive her.

Onika Thompson

She tried to distance herself from others. Luckily Onika’s strong support system rallied behind her and shrouded her with love and encouragement.

She spoke to a minister and a fellow survivor who helped her process the changes.

Two weeks after her first s u r g e r y, she needed a n o t h e r.

The doctors discovered that her breast cancer was invasive and therefore lymph nodes in her arm were removed. Her surgery was successful and Onika is thriving.

Onika stressed the importance of regular cancer screening because with early detection you can treat it as soon as possible. If it weren’t for that one symptom that prompted her to go to the hospital, doctors told her that it would have been too late.

About CCRI CCRI is a registered not-forprofit organisation with a mission to increase cancer research capacity and offer evidence-based solutions for cancer prevention and management in the Caribbean.

Through CCRI’s Telehealth service, patients can access convenient, high-quality virtual oncological consultations at subsidised cost.

First consultation is free.

Service is currently targeted to cancer patients in the Caribbean.

For more information, visit www.ccrinitiative.com

Tuesday, October 26, 2021 guardian.co.tt

ARE YOU READY FOR YOUR BREAST SCREENING? JYOTI PRIYA DEONARINE

S

creening for breast cancer means looking for signs of breast cancer in all women, even if they have no symptoms. The goal of screening is to catch cancers early. Early-stage cancers are easier to treat than later-stage cancers, and the chance of survival is higher.

Routine screening for breast cancer lowers one’s risk of dying of breast cancer.

Every day at Pink Hibiscus Breast Health Specialist Centre many patients are booked to have their Breast Screening done, we are always bombarded by calls from patients asking: “How to prepare for a Mammogram?”

To prepare for a mammogram only takes a few simple steps and a few helpful tips: When is the right time to schedule your appointment?

Your breast screening should be scheduled when your breasts are least tender; for women who are not into menopause, this is usually during the week after your menstrual period.

Can I have a mammogram if I am breastfeeding?

Lactating breasts tend to be dense because they are filled with milk which can make interpreting mam-

Jyoti Deonarine (RR) Mammographer Pink Hibiscus Breast Health Specialists mograms more difficult. Therefore it is recommended for women to completely finish lactating before having their mammograms done. If a patient is symptomatic they can still be seen by a physician and a breast ultrasound can be performed in the interim.

What should I bring?

It is always advisable for patients to walk with their previous imaging and reports (mammograms and breast ultrasounds) for a comparative study to be performed and any changes can be noted.

What can I wear?

Patients are advised to wear a two-piece outfit, so it’s easier to remove your top and bra for your screening examination.

On the day of the exam, patients are advised to avoid using : Powder • Lotions • Creams • Perfumes Deodorants under their arms, breast and chest area. Some patients ask “why?”. It is simply because certain products contain microscopic materials and particles which can mimic microcalcifications (specks of calcium) on a mammogram. In a previous article mention was made that the morphology of calcifications is an important factor in deciding whether they are typically benign or not, therefore by not applying these products it reduces this false negative report and there is no confusion by the radiologist reporting on the images.

To ensure this is done, cleansing wipes are provided to remove deodorant or any other products applied to the skin in the area of examination.

Can I eat?

Yes! You can absolutely have your regular meals when attending your breast screening appointment.

So there you have it, some simple tips to guide you with your preparation when you have scheduled your breast screening appointment.

Don’t be afraid of a mammogram. If you know what will happen and how to get yourself ready for the procedure, your fears will ease. It’s normal to feel anxious, but there’s no need to be so afraid that you put off the process. A mammogram can save your life.

Jyoti Deonarine (RR) Mammographer Pink Hibiscus Breast Health Specialists

Tuesday, October 26, 2021 guardian.co.tt

ACT

EARLY

STEPS FOR BREAST SELF-EXAMINATION

Stand in front of mirror with your shoulders straight and your arms on your hips. Look at your breast for usual size, shape and color.

Consult your doctor if you see any of the following changes: • Dimpling, puckering or bulging of the skin • A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out) • Redness, soreness, rash or swelling

Now, raise your arms and look for the same changes: • Usual size • Shape and color

Look for any signs of fluid coming out of one or both nipples.

Lie down back, using your right hand to feel your left breast and then your left hand to feel your right breast.

- Use the fingertips of 3 middle fingers to feel lump in your breast.

- Move your fingertips in circular motion to feel the breast tissue with 3 different levels of pressure- light pressure to feel the tissue closest to skin, medium pressure to feel a little deeper, firm pressure to feel the tissue closet to the chest and rib.

- Finally, feel your breasts while you are standing or sitting.

- Cover your entire breast, using the same hand movements described in step 4.

References: The Five Steps of a Breast Self-Exam at: http//www.breastcancer.org/symptoms/testing/types/self_exam/bse_steps accessed on 10 oct 2017.

Disclaimer: The information presented is for education purpose only and does not substitute medical advice from your Physician.

Please consult your treating physician for any further advice and treatment.

M-TT-00000111

Tuesday, October 26, 2021 guardian.co.tt