Bma Illustrated Medical Dictionary

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 tendernessSoreness 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 premenst-

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 mas-

titis. During lactation, it may be due to

engorgement with milk. Rarely, tender-

ness may be due to a breast cystor

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 attacksPeriods 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.

breathingThe 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

the brainstem. 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

also respiration.)

BREAST TENDERNESS BREATHING

B

Air enters

expanding

lungs

INHALATION EXHALATION

BREATHING

Air is

inhaled

Ribs move

upwards and

outwards

Air is

squeezed

out of

contracting

lungs

Air is

exhaled

Ribs move

downwards

and inwards

Diaphragm

contracts

and

flattens

Diaphragm

relaxes and

moves

upwards