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Use the pads of your fingers.

Feel your breast in overlapping areas.

Some research suggests that many women do breast self-examinations more thoroughhly when they use a pattern of up-and-down lines or strips. Other women feel more comfortable with another pattern. The important thing is to cover the entire breast and to pay special attention to the area between the breast and the underarm, including the underarm itself. Check the area above the breast, up to the collarbone and all the way over to your shoulder.

Feel the tissue by pressing your fingers in small, overlapping areas about the size of a dime. To make sure that you cover your entire breast, take your time and follow a definite pattern; circles, lines, or wedges (see above).

Figure 12.2

Breast Self-Exam (BSE)

Figure 12.2

Breast Self-Exam (BSE)

Step 6

Repeat step 5 lying down. Lie flat on your back, with your left arm over your head and a pillow or folded towel placed under your left shoulder. This position flattens the breast and makes it easier to examine. Check the left breast and the area around it very carefully, using one of the patterns described in step 5. Repeat the exam on the right breast.

Step 7

Some women repeat step 5 in the shower. Your fingers will glide easily over soapy skin, so you can concentrate on feeling for changes underneath.

Step 6

Repeat step 5 lying down. Lie flat on your back, with your left arm over your head and a pillow or folded towel placed under your left shoulder. This position flattens the breast and makes it easier to examine. Check the left breast and the area around it very carefully, using one of the patterns described in step 5. Repeat the exam on the right breast.

If your breasts are large, you may need to hold the side of each one steady with your other hand while you are performing the examination.

Step 7

Some women repeat step 5 in the shower. Your fingers will glide easily over soapy skin, so you can concentrate on feeling for changes underneath.

regularly with your physician. If you are approaching menopause, discuss your options for hormone replacement therapy (HRT). Menopausal symptoms, your potential for developing osteoporosis, and your risk for developing cardiovascular disease should be part of this discussion.

Men's Concerns

Conditions of the prostate gland. The prostate gland straddles the urethra and is the size of a chestnut. It is shaped like a doughnut and is gray to red in color. It contains and secretes fluid involved in the ejaculation of seminal fluid. Benign prostatic hypertrophy (enlargement) is one of the most common conditions affecting middle-aged and older men. Enlargement can interfere with the flow of urine, because the prostate surrounds the urethra, the tube that carries urine out of the bladder. This enlargement is identified through a rectal examination and a blood test called prostate-specific antigen (PSA). Prostatic hypertrophy can be treated with medication to reduce the swelling or with surgery performed by a urologist.

Prostate cancer is now the most common form of cancer in men. About 100,000 men are diagnosed with prostate cancer each year. Most men do not die from the disease.

Treatment for prostate cancer may consist of surgery, radiation therapy, chemotherapy, or a combination of regimens.

The most important element in the treatment of prostate cancer is diagnosis. If you are over age 50, you should visit your physician annually for a checkup. African-Americans or men with a family history of prostate cancer should start at age 40. The prostate gland should be examined for enlargement, hardness, or lumps.

Testicular cancer. The testes are walnut-shaped glands that reside in a protective sac called the scrotum (see Figure 12.3). The primary functions of the testes are to produce sperm and hormones, called androgens, that become testosterone. As sperm are manufactured, they travel through a tube called the epididymis, into another tube, the vas deferens, where they are stored. The testes of a young adult male produce about 120 million sperm each day. During intercourse, fluids from the prostate and seminal vesicles and sperm from the vas deferens are pumped into the upper part of the urethra, where they mix. This mixture comes out of the urethra during intercourse.

Testicular cancer, while not as common as prostate cancer, can occur throughout a

Figure 12.3

Male Reproductive Anatomy

Figure 12.3

Male Reproductive Anatomy

Scrotum

Ductus -deferens

Seminiferous tubules

man's lifetime. It is most common among men between the ages of 20 and 35. Two groups are particularly susceptible: men whose testicles descended into the scrotum after age 6, and men whose testicles never descended. Men who were born with low birth weight are also at higher risk. If the disease is diagnosed early, survival from testicular cancer is better than 90 percent.

It is extremely important for a man to perform testicular self-examination on a monthly basis (see Figure 12.4). You need to become familiar with the usual size, shape, and consistency of your testicles. They should be smooth, egg-shaped, and firm. Also note the color of your scrotum, the sac of skin that holds your testicles. Do not be alarmed if one testicle is larger than the other. This is normal. You may also feel a cordlike structure on the top and back of each testicle. This is the epididymis. Try to perform your self-examination after a warm bath or shower because the scrotal skin is looser at the time. Visually inspect for changes of color and appearance. Examine each testicle with both hands by placing the index and middle fingers under the testicle and the thumbs on top. Gently roll, feeling for changes. The first sign of testicular cancer is usually a hard, painless lump the size of a pea. Also examine the penis for lumps, sores, ulcers, or changes in color.

Epididymitis. Other problems, such as epididymitis (inflammation of the epididymis), may go unrecognized without self-examination or visual inspection. Men with MS may have diminished hand function or sensation. Examination by a spouse or care provider will be a key factor in the early identification of changes and potential problems. Lumps, redness, swelling, pain, or discharge should signal the need for contact with a physician and prompt medical attention.

Figure 12.4

Testicular Self-Exam (TSE)

Figure 12.4

Testicular Self-Exam (TSE)

1.

When and how to do a testicular self-exam

Try to perform TSE after a warm bath or shower. The scrotal skin will be loose and the testes easier to examine. Follow these steps:

Visually inspect the scrotum for changes in color—reddening, for example—or appearance, such as darkening.

Examine each testicle with both hands by placing the index and middle fingers under the testicle and the thumbs on top. Gently roll the testicle between the thumbs and fingers, feeling for any changes—whether it's more or less firm or whether there are lumps, swelling, or painful spots. The first sign of testicular cancer is usually a hard, painless lump about the size of a pea.

Follow the same procedure on the other testicle.

Also examine the penis for lumps, sore, ulcers, or a change in color.

What to expect if you find something abnormal

If you find a lump—or any other abnormality— make an appointment with your doctor right away. The doctor will want to see you to rule out less serious causes. Inflammation, for instance, can be caused by viral or bacterial infection. Swelling may be the result of swollen veins within the scrotum, a collection of fluid, or a cyst.

If the doctor suspects cancer, he or she will refer you to a surgeon who will need to remove the testicle for direct examination. There's no other way to confirm the diagnosis. If cancer is confirmed and it's in an early stage, the removal of the testicle may have been enough to cure the disease.

The surgeon will also order a CT or ultrasound scan and lab tests to see if cancer may have spread to other parts of the body. Even if there's no sign of spread, the surgeon may suggest radiation therapy to the remaining testicle and lymph glands as a precaution. If the disease has spread, chemotherapy is likely.

Although removal of a testis for diagnosis reduces sperm count, it doesn't interfere with sexual function or preclude reproduction. Dealing with the loss of a testicle may well be difficult for you, but you can take comfort in knowing that by doing TSE, you've maximized your chances of surviving this disease.

Additional Information For additional information about cancer, self-examination, or other issues see Appendix A, Resources.

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