Readings and Resources
Zastrow, C., Kirst-Ashman, K.K. & Hessenauer, S.L. (2019). Empowerment series: Understanding human behavior and the social environment (11th Ed.). Cengage Learning.
· Chapter 10: Biological Aspects of Young and Middle Adulthood
· Chapter 11: Psychological Aspects of Young and Middle Adulthood
· Chapter 12: Social Aspects of Young and Middle Adulthood
Articles, Websites, and Videos:
Determinants of health are those factors which can influence a person’s health. They include the conditions under which we are born, grow, live and advance in age and each is critically important to determining not only the health of an individual, but also a community.
What questions should be asked while making the decision to move in with your partner? In this easy to listen to video, 8 practical questions are asked and answered which should be considered prior to making that decision. Do these seem logical to be considered? They range from thinking about the long term relationship you are considering with your partner to finances and how responsibilities are to be shared. As you watch this, what additional questions come to your mind?
This video will explore how the toxic stress children experience while growing up in poverty negatively affects their brains. Furthermore, it explains how we all have a responsibility to address poverty and the need to intervene within our communities for those who are most vulnerable.
Biological Aspects of Young and Middle Adulthood
Roy Morsch/Corbis/Getty Images
This chapter will help prepare students to
· LO 1 Recognize the contributions of physical development, health status, and other factors to health during young adulthood
· LO 2 Describe the physical changes in middle adulthood, including those affecting physical appearance, sense organs, physical strength and reaction time, and intellectual functioning
· LO 3 Describe the midlife crises associated with female menopause and male climacteric
· LO 4 Summarize sexual functioning in middle age
· LO 5 Describe AIDS—its causes and effects; how it is contracted; how its spread can be prevented; and understand AIDS discrimination
Shannon Bailey, age 22, is a senior in college, majoring in English. She is nearing graduation and is seeking a career focus. She realizes that a degree in English will indicate to potential employers that she probably writes well. Yet she also knows that an English major is not linked to professional positions the way a degree in engineering, for example, is linked to engineering positions. She is confused about what kind of career she wants, and also what kind of career she is qualified for.
Shannon is nervous about finding a job as she knows she will soon need to pay back student loans. Although her parents had saved some money for her education, she still has $19,000 in student loans. She is hoping to find a job that will provide her enough money to afford the life style she wants while allowing her to pay back her loans.
To add to her confusion, Eric Kim, whom she has been dating for three years and who is two years older than she, proposed to her a week ago. He wants to get married in a year or two.
At first, Shannon was flattered by the proposal and accepted the ring. But now she is having second thoughts, as she does not know if she wants to be in a committed relationship with Eric for the rest of her life. Shannon realizes that the decisions she makes in young adulthood will have a major impact on the rest of her life-including her health, well-being, and happiness.
Shannon’s parents, Patrick and Laura Bailey, are in the middle adulthood phase of their lives. They have been married for 23 years and have had relatively few serious conflicts. Shannon is their only living child; another child died of sudden infant death syndrome when he was 8 months old. This was very traumatic for them for several years.
More recently, Patrick’s father died from a heart attack. Although their three other parents are still living, they are worried about Patrick’s mother living alone, their parents declining health, and what the future will look like with aging parents. Patrick, who is 50, has been employed as a construction worker most of his adult life. Due to a recession that impacted the housing industry, he was unemployed from 2009 to 2011, creating a heavy financial burden on his family. Luckily, Laura, age 48, has been a carrier for Federal Express for the past 13 years and had more stability in her income. They feel they are just getting back on their feet and are grateful there home was not foreclosed on, as had happened to several of their friends and family members during this time. However, they do still have some outstanding debts, mainly credit cards, and are resuming contributions to their retirement accounts.
They are active in church activities and enjoy taking walks, gardening, playing softball, and bowling. For the past five summers, they have been spending their vacations traveling to various places in the United States in their Buick Enclave SUV.
Young adulthood is both an exciting and a challenging time of life. Growth and decline go on throughout life, in a balance that differs for each individual. In young adulthood, human beings build a foundation for much of their later development. This is when young people typically leave their parents’ homes, start careers, get married, start to raise children, and begin to contribute to their communities.
Middle adulthood has been referred to as the prime time of life. Patrick and Laura Bailey illustrate this. Most people at this age are in fairly good health, both physically and psychologically. They are also apt to be earning more money than at any other age and have acquired considerable wisdom through experiences in a variety of areas. However, middle adulthood also has developmental tasks and life crises. This chapter will examine human biological subsystems in young and middle adulthood and discuss how they affect people’s lives.
10-1Recognize the Contributions of Physical Development, Health Status, and Other Factors to Health during Young Adulthood
It is difficult to pinpoint the exact time of life we are referring to when we talk about young adulthood. The transition into adulthood is not a clear-cut dividing line. People become voting adults by age 18. However, in most states, they are not considered adult enough to drink alcoholic beverages until 21. A person cannot become a U.S. senator until age 30 or president until age 35. All this presents a confusing picture of what we mean by adulthood.
Various theorists have tried to define young adulthood. Buhler (1933) clustered adolescence and young adulthood together to include the ages from 15 to 25. During this time, people focus on establishing their identities and on idealistically trying to make their dreams come true. Buhler saw the next phase as young and middle adulthood. This period lasts from approximately age 23 to age 45 or 50. This group focuses on attaining realistic, concrete goals and on setting up a work and family structure for life.
Levinson, Darrow, Klein, Levinson, and McKee (1974) broke up young adulthood into smaller slices. They believed that in the process of developing a life structure, people go through stable periods separated by shorter transitional periods. The stage from ages 17 to 22 is characterized by leaving the family and becoming independent. This is followed by a transitional phase from ages 22 to 28, which involves entering the adult world. The age-30 transition focuses on making a decision about how to structure the remainder of life. A settling-down period then occurs from about ages 32 to 40.
The current generation of young adults is called the millennials, compared to past generations who held the titles of baby boomers, Generation X, and upcoming (Generation Z). Currently there are 50 million millennials who grew up in the twenty-first century and the digital age. These young adults have learned to navigate the ever-changing world of technology and have faced traumas such as the terrorist attacks of September 11, 2001, and the recession of 2008–2009 (Tanenhaus, 2014).
Ethical Question 10.1
1. Are you taking good physical care of yourself?
For our purposes, we will consider young adulthood as including the ages from 18 to 30. This is the time following the achievement of full physical growth when people are establishing themselves in the adult world. Specific aspects of young adulthood addressed in this chapter include physical development, health status, and the effects of lifestyle on health.
Young adults are in their physical prime. Maximum muscular strength is attained between the ages of 25 and 30, and generally begins a gradual decline after that. After age 30, decreases in strength occur mostly in the leg and back muscles. Some weakening also occurs in the arm muscles.
Top performance speed in terms of how fast tasks can be accomplished is reached at about age 30. Young adulthood is also characterized by the highest levels of manual agility. Hand and finger dexterity decrease after the mid-30s.
Sight, hearing, and the other senses are their keenest during young adulthood. Eyesight is the sharpest at about age 20. A decline in visual acuity isn’t significant until age 40 or 45, when there is some tendency toward presbyopia (farsightedness). At that point, you start to see people read their newspapers by holding them 3 feet in front of them.
Hearing is also sharpest at age 20. After this, there is a gradual decline in auditory acuity, especially in sensitivity to higher tones. This deficiency is referred to as presbycusis. Most of the other senses—touch, smell, and taste—tend to remain stable until approximately age 45 or 50.
Young adulthood can be considered the healthiest time of life. Young adults are generally healthier than when they were children, and they have not yet begun to suffer the illnesses and health declines that develop in middle age. (Papalia & Martorell, 2015)
Most young adults report they are in good to excellent health (Papalia & Martorell, 2015). However, rates of injury, homicide, and substance abuse peak at this time (Papalia & Martorell, 2015). In the past, this age group has lacked access to health care, often aging out if they did not go to college or if there were age limits on their parents’ insurance, but with the Affordable Care Act of 2010, most young adults can stay on their parents’ insurance plan until the age of 26. This change has resulted in 5.7 million young adults having health care coverage (The White House, 2015) and allowing young adults the health care they require to prevent or address health concerns. However, the Trump administration has indicated it plans to repeal/replace the Affordable Care Act, which could impact the health care of young adults.
Many people in all socioeconomic classes show a significant interest in measures that promote health. For example, running and other forms of exercising, health foods, and weight control have become very popular.
It has also been found that adults in the United States are using more complementary medicine approaches, including dietary supplements, yoga, chiropractors, meditation, acupuncture, massage therapy, and/or osteopathic manipulation. In 2012, in the National Health Interview Survey, it was found that 33.2 percent of adults used complementary health approaches (NCCIH, 2016).
Even though young adulthood is generally a healthy time of life, health differences can be seen between men and women. For example, women of all ages tend to report more illnesses than do men (Lefrancois, 1999). However, these health issues may be related to gender (such as contraception, pregnancy, or an annual Pap test), rather than more general health problems. Perhaps women are also more conscientious about preventive health care in general.
Of all the acute or temporary pressing health problems occurring during young adulthood, approximately half are caused by respiratory problems. An additional 20 percent are due to injuries. The most frequent chronic health problems of young adulthood are spinal or back difficulties, hearing problems, arthritis, and hypertension. These chronic problems occur even more frequently in families of lower socioeconomic status. For example, young African Americans experience hypertension more frequently than their white counterparts (Papalia & Martorell, 2015).
Other health concerns are also on the rise for young adults. Alarmingly, people ages 15–24 account for half of the 20 million newly diagnosed sexually transmitted infections yearly in the United States (CDC, 2015). Obesity rates are of concern with young adults, along with increases in stress levels, lack of sleep, smoking, and alcohol use (Papalia & Martorell, 2015).
A 21-year-old male, who has been healthy his entire life, has a pain in his groin area. As he is a student athlete, he assumes it is a pulled muscle and ignores it. Despite the continued discomfort it causes, he believes it is not healing properly due to his continued training. By the time he seeks care, it is too late. He has untreatable prostate cancer. The following year, his family accepts his college diploma on his behalf as he died several months prior to graduation.
This case highlights the need for males to seek medical care. In 2014, 83.2 percent of adults visited a physician; however, the majority of these visits were made by females (CDC, 2015b). Despite recommendations that men visit their primary physician once every two years. (However, it is recommended they go more routinely if they smoke, have high blood pressure, or have high cholesterol.) Between the ages of 18 and 39, men do not visit the physician as often as women, especially for preventive care (CDC, 2015b). The leading causes of death for men are heart disease, cancer, and accidents (CDC, 2015c). Of cancer, the most frequent diagnoses are prostrate, lung, and colorectal; however, lung cancer causes the most deaths (CDC, 2015a). Many of the health issues faced only by men, such as prostate cancer or low testosterone, can be prevented or treated successfully if caught early (NIH, 2016b). It is critical that young males be encouraged to seek routine, preventive health care in order to live to their fullest potential.
Women and Health
Although women do tend to visit the physician more than men, as indicated above, women have unique needs, such as pregnancy, conditions of female organs, and breast health that need to be routinely monitored. Women also have a higher incidence than men of certain health risks; for example, women are more likely to die following a heart attack than men, are more likely to show signs of depression, are affected more often by osteoarthritis, and are more likely to have urinary tract problems (NIH, 2016c). The leading causes of death for women are heart disease, cancer, and chronic lower respiratory disease (CDC, 2016b).
Within the context of health status, an extremely important issue confronting women is the incidence of breast cancer. According to the American Cancer Society (ACS, 2016b), breast cancer is the most common form of cancer among women, except for skin cancer. Approximately 1 out of 8 women will get breast cancer during their lifetime, and about 40,450 women will die from it in every year (ACS, 2016b). It is the second leading cause of cancer death in women, second only to lung cancer (ACS, 2016b). Although men can get breast cancer, the numbers are significantly lower than those of women, with 2,600 cases diagnosed in men each year and 440 reported deaths (ACS, 2016d).
Although older adult women are much more likely to get breast cancer than their younger counterparts, because of its general prevalence it will be discussed here.
Being knowledgeable about the issue of breast cancer is especially important in helping your female clients become aware of risks, prevention, and treatment. If you are a woman, it’s important for your own health. If you are a man, it’s important for the women who are close to you.
To begin with, it’s important to note that 80 percent of all breast lumps are benign (not cancerous) (Hyde & DeLamater, 2017). These usually take one of two forms (Crooks & Baur, 2014). First, there are cysts, which are pouches of fluid. The other form of lump is a fibroadenoma, which is a more solid, rounded growth of cells resembling scar tissue (Crooks & Baur, 2014, p. 81).
A number of symptoms other than identification of a lump or tumor can indicate malignancy. Tumors can assume a number of shapes and forms. Generally, any change in the external appearance of the breasts should make one suspicious. For instance, one breast becoming significantly larger or hanging significantly lower than the other is a potential warning sign. Discharges from the nipple or nipple discoloration are additional indications, as is any pain in the breast. Dimpling or puckering of the nipple or skin of the breast should be noted. Nipple retraction (where the nipple turns inward) is also a potential sign of cancer. Finally, any swelling of the upper arm or lymph nodes under the arm should be investigated.
Numerous factors are involved in getting breast cancer (ACS, 2016a). Some are variables that can’t be changed. We have already established that being a woman and advancing age increase risk. About two-thirds of women with breast cancer are age 55 or older by the time the cancer is discovered.
Between 5 and 10 percent of breast cancers are related to genetic mutations, most frequently in the genes labeled BRCA1 and BRCA2 (ASC, 2016e). Women with mutations in these specific genes may increase their likelihood of breast cancer by as much as 80 percent. Note that mutations in other genes may also be linked to increased risk.
Genetic testing can be done to determine if a female has BRCA1 or BRCA2 mutations, but women are encouraged to talk to a genetic counselor or doctor to explain the results (ACS, 2016e).
Family history is another relevant variable in assessing breast cancer risk. Having close female relatives on either side of the family with breast cancer increases a woman’s chances. Risk doubles for women who have a mother, sister, or daughter who has breast cancer and triples for women with two such relatives. (However, note that over 85 percent of all women with breast cancer do not have it in their family history.) Having a prior history of breast cancer increases the chances of developing a new cancer in the same or the other breast.
Race affects risk. “White women are slightly more likely to get breast cancer than are African American women but African American women are more likely to die of this cancer. However, in women under 45 years of age, breast cancer is more common in African American women. Asian, Hispanic, and American Indian women have a lower risk of developing and dying from breast cancer” (ACS, 2016).
Women who have been exposed to radiation treatment in the chest area at some earlier time have greater risk. Risk may also be related to menstruation. It increases a bit for women who started menstruating before age 12 or who went through menopause (the normal change of life occurring in middle age when a woman stops menstruating and can no longer bear children) after age 55. Having dense breast tissue (the fatty, fibrous, and glandular tissue making up breasts) increases the risk of developing breast cancer. Additionally, having been diagnosed with certain benign breast conditions (e.g., certain benign breast tumors) also increases breast cancer risk, although the level of risk varies with the particular condition.
Some risk factors for breast cancer are linked to lifestyle and life choices. Risk increases slightly for childless women and for women having their first child after age 30. Conversely, having numerous pregnancies and bearing children at a young age reduces a woman’s chance of getting breast cancer. The risk posed by taking oral contraception (birth control pills) is not yet understood. Studies have found that women now using birth control pills have a slightly greater risk of breast cancer than women who have never used them. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk. Women should address issues such as this with a physician. Long-term use of combined hormone therapy (HT) with estrogen and progesterone to diminish the negative symptoms of menopause increases the risk of breast cancer and of dying from the disease. The use and effects of hormone therapy are complex and should be carefully discussed with a physician. Since combined HT also “appears to increase the risk of heart disease, blood clots, and strokes,” “there appear to be few strong reasons to use post-menopausal hormone therapy” (ACS, 2016c). Alcohol consumption, especially in greater quantities on a regular basis, increases risk, as does being overweight.
Several other factors that may contribute to the risk of breast cancer are under investigation. However, research results aren’t clear at this time. These factors include high-fat diets, chemicals in the environment, tobacco smoke, and working at night. In contrast, exercise appears to reduce risk, as does having breast-fed a child, especially if the practice lasted for one-and-a-half to two years.
Remember that the factors discussed here do not condemn a woman to getting breast cancer. Such discussion should only alert women to be careful and aware.
Suspicion of Breast Cancer
In the event that a suspicious lump is detected, numerous options can be pursued. First, a mammogram (X-ray of the breast) can be used to detect a tumor. (Note that mammograms are also used for regular screenings, described later.) Improvements in mammogram technology have resulted in decreased amounts of radiation, so there is little if any risk of negative consequences. Diagnostic mammograms “are used to diagnose breast disease in women who have breast symptoms (like a lump or nipple discharge) or an abnormal result on a screening mammogram” (ACS, 2016a). They involve taking more images depicting greater detail of the suspicious area in the breast.
Second, magnetic resonance imaging (MRI) scans “use radio waves and strong magnets instead of x-rays” (ACS, 2016a). A dye is injected into the bloodstream to accentuate effects. Healthy and diseased bodily tissues absorb the energy in different ways so that a computer can interpret results and discover abnormalities. Some research has found that MRIs can discover more and smaller cancers than can mammograms. However, MRIs are more expensive, may take up to an hour, and involve being confined in a tube (which makes some people quite uncomfortable). In current practice, MRIs are usually used along with mammograms to screen women in high-risk groups, to investigate suspicious tissue, to determine the mass of a cancer that has already been detected, or to check for the existence of cancer in the opposite breast. New imaging tests are also being studied.
Third, an ultrasound (picture of an internal area by the use of sound waves) may also be employed. Ultrasound has become a valuable tool to use along with mammography because it is widely available and less expensive than other options such as MRI. The use of ultrasound instead of mammograms for breast cancer screening is not recommended. Usually, breast ultrasound is used to target a specific area of concern found on the mammogram. Ultrasound helps distinguish between cysts (fluid-filled sacs) and solid masses and sometimes can help tell the difference between benign and cancerous tumors.
Ultrasounds can be beneficial in assessing breasts with exceptionally dense tissue, as tumors may be more difficult to see in mammograms. Research is currently being done to determine the value, pros, and cons “of adding breast ultrasound to screening mammograms in women with dense breasts and a higher risk of breast cancer” (ACS, 2013c).
Fourth, for women with nipple discharge, a ductogram (or galactogram) can be performed. This involves inserting “a very thin plastic tube into the opening of the duct in the nipple” producing the discharge and injecting a very small quantity of a liquid into the duct (ACS, 2016a). This provides a contrast between the injected liquid and breast tissue, thus delineating the structure of the duct. An X-ray can then determine if a mass exists within the duct.
Fifth, a biopsy involves extracting some amount of tissue to examine for cancerous cells. In a fine needle aspiration biopsy (FNAB), an extremely fine needle extracts fluid from the lump for evaluation. In a core needle biopsy, a larger needle is used to remove several cores of tissue from a potentially problematic area discovered during an ultrasound or mammogram. “Because it removes larger pieces of tissue, a core needle biopsy is more likely than an FNAB to provide a clear diagnosis, although it may still miss some cancers” (ACS, 2016c). Vacuum-assisted biopsies such as Mammotome® or ATEC® (Automated Tissue Excision and Collection) (trade names) are outpatient procedures that involve the suctioning of tissue using a hollow probe through a small incision. A surgical biopsy entails a removal by incision of a larger section of the identified mass or abnormal area in addition to some of the surrounding tissue. This more complex procedure, used because of the tissue’s location or because the results of a core biopsy are unclear, is usually performed in a hospital’s outpatient unit and requires anesthesia. The type of biopsy selected depends on a woman’s specific circumstances. “Some of the factors your doctor will consider include how suspicious the lesion appears, how large it is, where in the breast it is located, how many lesions are present, other medical problems you may have, and your personal preferences” (ACS, 2016c).
Treatment of Breast Cancer
If it is established that the lesion is cancerous, several treatment options are available (National Cancer Institute [NCI], 2016a). The type of treatment depends on the complexity, severity/progression of the cancer. Women with breast cancer need to explore all of the options with their doctor to determine their best course of action based on their individual situation. The standard treatment options used are listed below.
1. Surgery: Surgery removes the cancer. During surgery lymph nodes may be removed because they are the first structures to receive drainage from the tumor (NCI, 2016c). The sentinel lymph node is the lymph node to receive the drainage first. This lymph node is evaluated for cancer cells and if no cancer cells are found, removal of more lymph nodes may be unnecessary. Different types of surgery include
partial mastectomy: removal of a portion of the breast containing the tumor, tissue around the tumor, and possibly the chest muscle below the cancer.
simple or total mastectomy—the entire breast is removed and possibly some lymph nodes under the arm.
skin-sparing mastectomy: the same amount of internal breast tissue is removed as a simple mastectomy, but the breast remains intact in preparation for breast reconstruction surgery (Mayo Clinic, 2016b).
modified radical mastectomy: “many of the underarm lymph nodes, the lining over the chest muscles, and sometimes part of the chest wall muscles are removed” (NCI, 2016c).
2. Radiation: Radiation therapy involves using “high-powered beams of energy, such as x-rays to destroy cancer cells” (Mayo, 2016a). Radiation can be administered externally (outside the body with a machine) or internally (place radioactive substances in the body). Treatment schedules vary depending on the stage of the cancer treated (NCI, 2016c).
3. Chemotherapy: Chemotherapy involves administering cancer fighting drugs either by injecting them into the vein or ingesting them in liquid or pill form. They are intended to fight and eliminate cancer cells that have split off from the tumor and migrated to other parts of the body. The way chemotherapy is given depends “on the type and stage of the cancer being treated” (NCI, 2016c). Chemotherapy may be used before surgery to shrink a tumor, thereby facilitating the tumor’s removal.
4. Hormone therapy: Hormone therapy involves administration of drugs that block or decrease the effects of the female hormone estrogen in those women whom estrogen encourages the development of breast cancer. One example of hormone therapy is tamoxifen, a drug in pill form that is usually administered for two to five years after breast cancer surgery.
5. Targeted drugs: Targeted drug treatments attack specific cancer cells without harming normal cells (NCI, 2016c). These drugs may kill the cancer cell or slow the cells’ growth.
6. Clinical trials: Some patients take part in a clinical trial to determine if a new cancer treatment is safe and effective or better than the standard treatments as identified above (NCI, 2016c).
All of the treatment options noted may have side effects, ranging from tiredness, hair loss, and premature menopause to greater vulnerability to infections and diseases because of decreased supply of white blood cells. Additionally, when a woman has surgery on her breast it can affect her self-esteem due to tremendous significance placed on breasts in our society. A women’s perception of herself, how others perceive her, and of the effects on her sexual relationships can be severely affected.
One option, for women who have had a mastectomy is reconstructive surgery. Reconstructive surgery is done to make the breast look as natural as possible. In 2015, 106,338 breast reconstruction procedures were performed in the United States (American Society of Plastic Surgeons, 2016). Reconstruction surgery can be performed during the initial surgery (which must be planned in advance) or at a later time. As a last resort, some women turn to alternative or complementary medicine to help fight their cancer. It should be noted, however, that no alternative treatments have been found to cure breast cancer (Mayo, 2016a). Some of these options are acupuncture, a special diet, meditation, and/or yoga. It is believed these treatments can help treat the patient’s mind, body, and spirit (NCI, 2016b).
Many procedures and therapies exist to combat breast cancer. However, early detection is key to effective treatment. Highlight 10.1 describes what women can do to facilitate detection as soon as possible.
Early Detection of Breast Cancer
There are three primary recommendations for early detection of breast cancer. First, the American Cancer Society strongly recommends that women should have an annual mammogram beginning at age 40. Women with a high risk of breast cancer should discuss the issue of having mammograms or other screening tests conducted at an earlier age. Some high-risk women should consider having an annual MRI in addition to their mammogram.
Second, beginning in their 20s or 30s, women should begin having a clinical breast exam (CBE) performed by a health care practitioner at least every three years. Note that many cancers cannot currently be detected by mammography. CBE exams involve the practitioner examining your breasts for abnormalities or changes. The practitioner will also use the pads of her fingers to search for lumps in the breast and under the arms.
The third means of early detection involves conducting a breast self-exam (BSE) beginning in your 20s. The idea is that getting to know the contours and structure of your own breasts can help you detect any changes of abnormalities. You can develop much greater expertise in checking yourself than can a physician or other health professional who checks you only once a year or less. It has been suggested that women conduct a BSE monthly, or at least occasionally. The following describes how to do a BSE:
1. Lie down and put your left arm over your head (when checking your left breast with your right hand). This position spreads out the breast tissue more uniformly and allows you to explore the breast more thoroughly.
2. Use the pads on your three middle fingers to feel for lumps by using circular motions about the size of a dime.
3. Use three levels of pressure—mild, medium, and deep—in order to explore the depth of the entire breast.
4. Move in an up-and-down pattern, illustrated in Figure 10.1 (ACS, 2010a). You should start under your arm and make certain you check all areas of the breast down to the bottom of the lib cage and up to the collarbone.
5. Duplicate the procedure using the three middle fingers of your left hand to check your right breast. Don’t forget to put your right arm over your head.
6. Now get up and look at yourself in the mirror. Push your hands down tightly on your hips, as this tends to emphasize any changes in your breasts. Examine your breasts carefully for any differences or abnormalities.
7. Either standing or sitting in a chair, elevate your left arm slightly (do not raise it too high, as this tenses the muscles too much and makes it more difficult to detect lumps or ab