Breast self-examination with gynecologist Diane Bourgasser

Young gynecologist Diane Bourgasser shares how to perform a breast self-exam, a quick and effective technique (used in conjunction with mammograms) that also helps you get to know your breasts better. She also reminds us that lifestyle has a significant impact on the development of breast cancer.

Do you practice 'holistic' gynecological medicine, treating the patient as a whole?
We take a holistic approach to patient care. It would be incomplete not to consider their lifestyle, family history, personal history, and so on. We will therefore not provide the same care, follow-up, or communication in the same way. Each patient is different and requires an ability to adapt in order to ensure nothing is overlooked.


What is the most effective practice for breast cancer prevention (self-examination/mammography...)?
In France, organized breast cancer screening has been in place since 2004. This screening program is for women aged 50 to 74 who do not have any risk factors or specific symptoms of breast cancer. It consists of a mammogram every two years and a clinical breast exam by an accredited radiologist. Eligible women receive a letter at home inviting them to participate in this screening. As for breast self-examination, it is an effective method for becoming familiar with your body, but it is important to remember that it does not replace at least an annual examination by your general practitioner or gynecologist!

At what age do you recommend starting self-palpation and how often?
It's recommended to perform a breast self-exam every month starting from the beginning of your period. Honestly, I don't think any young girl does it that early, but I suppose you can start to get to know your breasts well once you start showering regularly. The sooner the better.

Can you explain to us how to perform self-palpation?
Self-palpation is performed standing up, facing a mirror, with bare breasts.
For the examination of the right breast:

- Begin by visually inspecting for any abnormalities: nipple retraction? orange peel appearance? lump? any unusual appearance

Raise your right arm and, using your left hand, begin the self-examination. With your index, middle, and ring fingers flat, palpate quadrant by quadrant (upper outer, upper inner, lower inner, lower outer) all around the nipple, then over the nipple itself. The palpation should be firm enough to clearly feel the mammary gland up to the chest wall. This palpation should look for a lump (mass, nodule), which may be firm, soft, mobile or immobile, painful or not.

- Once the quadrants have been completed, focus on the nipple, gently squeeze it to check for discharge (which should prompt you to seek medical help quickly).

- Finally, still with your arm raised, palpate the area from the breast to the armpit in the same way, to also look for nodules.

For the examination of the left breast: do exactly the same thing!

Breast self-examination allows you to become familiar with your breasts and is essential for detecting abnormalities very early on, abnormalities which may not be serious at all. If you have any doubts, don't hesitate to consult your gynecologist or your general practitioner.

Should people with a family history of breast cancer be more vigilant?

Women with risk factors are those who have:

- a family history of breast cancer
- symptoms before age 50
- a lifestyle with increased risks of cancer: tobacco, alcohol, obesity...
These women should establish personalized follow-up care with a gynecologist or general practitioner. Closer monitoring with clinical examination and medical imaging can be offered earlier.

What habits increase the risk of cancer?
Lifestyle plays a significant role in the development of cancer. We are now able to identify behaviors that undoubtedly contribute to the development of malignant tumors.
Among the most common risk factors (and not just in breast cancer but in all cancers) are:
- tobacco
- alcohol
- obesity
- sedentary lifestyle
- type 2 diabetes etc...
Regarding breast cancer, we can also add:
- long-term use of estrogen-progestin contraception (fortunately, the risk decreases when this contraception is stopped)
- prolonged use of menopausal hormone replacement therapy (especially if it is estrogen-progestin)
- a first pregnancy late (after 30 years) or no pregnancy at all.

What are your tips for an 'anti-cancer' lifestyle?
As we hear everywhere, an anti-cancer lifestyle is simply a healthy lifestyle. A balanced diet, no tobacco, no excessive alcohol consumption, regular physical activity, good nights of sleep to avoid fatigue, stress, etc.