and other changes that might be an
indication of early
breast cancer.
To carry
out self-examination, the breasts should
be checked in a mirror for any dimpling
of the skin or changes in the nipples or
breast size and shape. Then, with one
arm behind the head, and using small
circular movements, the breast should
be gently but firmly pressed. The entire
breast, armpit area, and nipple should
be examined. Regular self-examination
helps a woman to become familiar with
the appearance and feel of her breasts;
any changes should be reported to a
doctor without delay.
breast tenderness
Soreness or tender-
ness of the breasts, often with a feeling
of fullness. Breast tenderness is an
extremely common problem. In most
women it is cyclical, varying in severity
in response to the hormonal changes of
the menstrual cycle. It is usually most
severe before a period (see
prem enst-
rual syndrome).
It tends to affect both
breasts and may be aggravated by
stress or caffeine in drinks. Breast ten-
derness can also be noncyclical and
may be caused by muscle strain or
During lactation, it may be due to
engorgement with milk. Rarely, tender-
ness may be due to a
breast cyst
breast cancer.
However, examination by
a doctor will exclude any underlying
problems. Women with large breasts
are more likely to suffer from both cycli-
cal and noncyclical breast tenderness.
Cyclical tenderness may be relieved
by reduced caffeine intake, relaxation
exercises for stress, a well-fitting bra, or
weight loss to reduce breast size. If
these measures do not work, hormonal
treatment may be recommended.
breath-holding attacks
Periods dur-
ing which a toddler holds his or her
breath, usually as an expression of pain,
frustration, or anger. The child usually
becomes red or even blue in the face
after a few seconds, and may faint.
Breathing quickly resumes as a natural
reflex, ending the attack. Attacks cause
no damage and are usually outgrown.
The process by which air
passes into and out of the lungs to
allow the blood to take up oxygen and
dispose of carbon dioxide. Breathing is
controlled by the respiratory centre in
. When air is inhaled, the
diaphragm contracts and flattens. The
intercostal muscles (muscles between
the ribs) contract and pull the ribcage
upwards and outwards. The resulting in-
crease in chest volume causes the lungs
to expand, and the reduced pressure
draws air into the lungs. When air is ex-
haled, the chest muscles and diaphragm
relax, causing the ribcage to sink and
the lungs to contract, squeezing air out.
In normal, quiet breathing, only about
a 10th of the air in the lungs passes out
to be replaced by the same amount of
fresh air (tidal volume). This new air
mixes with the stale air (residual vol-
ume) already held in the lungs. The
normal breathing rate for an adult at
rest is 13-17 breaths per minute. (See
previous page 94 BMA Illustrated Medical Dictionary read online next page 96 BMA Illustrated Medical Dictionary read online Home Toggle text on/off