Breast self-exams: One way to detect breast cancer

Many health professionals now consider breast self-exams optional rather than a mandatory part of breast cancer screening. What's stressed today is breast awareness — developing familiarity with your breasts and the underlying tissue.

Becoming familiar with your breasts makes it easier for you to notice any changes that develop — while it's still early enough to make a difference. Detection of breast cancer at an early stage can improve your chance of surviving the disease. If you're at increased risk of breast cancer, regular breast self-exams will increase your sense of breast familiarity.

To gain the greatest benefit from regular breast self-exams, ask your doctor to review your technique at your next checkup.

What is breast familiarity?

Breast familiarity refers to knowing how your breasts usually look and feel. You can do this by paying attention to changes to your breasts, such as:

• Development of a lump
• Change in size or shape
• Irregular thickening of breast tissue
• Nipple discharge
• Skin redness or warmth
• Dimpling or skin texture similar to an orange peel
• Retraction of the nipple or area surrounding the nipple (areola)

Performing regular breast self-exams is one way to increase your familiarity with your breasts and help you detect changes in your breast tissue.

At what age should you begin performing regular breast self-exams?

The American Cancer Society recommends that doctors inform women about the benefits and limitations of breast self-exams when they reach age 20. That's the age you should begin breast self-exams. Whether or not you perform breast self-exams, you should have a clinical breast exam by a health professional every three years until you're 40. After age 40, schedule a clinical breast exam and a mammogram every year.

Optimal timing for breast self-exams

The best time to perform a breast self-exam is about a week after the start of your period. That's when your breasts are least likely to be tender or swollen. Your breast tissue undergoes changes each month during your menstrual cycle. Changes in hormone levels associated with menstruation cause your breasts to swell. Once your period starts, the swelling subsides and your breasts return to normal.

During pregnancy and nursing, your breasts may feel lumpier than usual. If you have any questions about how your breasts look or feel, don't hesitate to ask your doctor about them.

How to perform a breast self-exam

A breast self-exam involves both visual and physical examination of your breasts.

Visual examination
Disrobe and stand in front of a mirror with your arms at your sides. Visually inspect your breasts while facing forward and while turning from side to side. You're looking for any signs of puckering, dimpling or changes in size, shape or symmetry. Check to see if your nipples are turned in (inverted). Look for these same signs with your arms in two other positions: hands on your hips and hands raised overhead, palms pressed together.

Physical examination
Examine your breasts either in the shower or while lying down with no shirt or bra on.

If you choose to perform the exam in the shower, lather your fingers and breasts with soap to help your fingers glide more smoothly over your wet skin. If you choose to examine your breasts while lying down, choose a bed or other flat surface to lie on.

You can use one of two patterns to examine your breasts:

• Clock pattern. Place your left hand behind your head and examine your left breast with your right hand. Think of your breast as the face of a clock. Place your right hand at 12 o'clock — at the very top of your breast. Using the pads of your three middle fingers, press firmly in a slight circling, massaging motion. Feel for lumps as you move your hand down to 1 o'clock then 2 o'clock, continuing until you return to 12 o'clock. Slide your fingers closer to the nipple and repeat the circling motion around the imaginary clock face. Continue in increasingly smaller circles until you reach the nipple. Check the tissue under the nipple and look for discharge. Also check the tissue under your armpit, as well as tissue surrounding the breast, using the same firm, circling motion.

  Place your right hand behind your head and repeat the examination on your right breast using your left hand.

• Wedge pattern. Place your left hand behind your head and examine your left breast with your right hand. Imagine your breast to be a circle divided into wedges, like pieces of a pie. Starting at the top of the circle about a half-inch below your collarbone, use the pads of your three middle fingers to examine your breast. Press firmly in a slight circling, massaging motion as you slide your fingers inward toward your nipple. Once you've examined the breast tissue in that wedge, move in a clockwise direction to the next wedge in the circle. Continue examining your breast in this manner until you've completely examined your breast and underarm.

  Place your right hand behind your head and repeat the examination on your right breast using your left hand.

As an alternative to the circling, massaging motion described for the clock and wedge patterns, you may find a sweeping technique somewhat easier to perform. With this technique you sweep your three middle fingers from your collarbone down to your nipple. Work in a clockwise direction, always sweeping your fingers from the outside of your breast in toward your nipple. To feel the deeper tissue, repeat the process using a walking motion with your fingers. Finally, check the lymph nodes under each arm.

No matter which technique you choose, be sure to check your nipple for any discharge. Do this by gently pinching the nipple with your fingers positioned at 12 o'clock and 6 o'clock and again with your fingers at 3 o'clock and 9 o'clock.

Touching or gently pressing a breast lump may cause some discomfort. If you do detect any changes or a lump, see your doctor promptly.

Patterns for breast self-exam

Patterns for breast self-exam

During a breast self-exam, you can choose one of two patterns: the clock pattern or the wedge pattern. Using the clock pattern, imagine your breast to be the face of a clock. Start at the 12 o'clock position and then move around the clock face until you return to 12 o'clock. Using the wedge pattern, imagine your breast as sectioned off like pieces of a pie. Examine each section in turn from the outer breast in toward your nipple.

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Fibrocystic breasts present a challenge

Fibrocystic breasts — breasts that are lumpy — are extremely common. This condition most frequently results from changes in hormone levels that occur during menstruation or with perimenopause and menopause. If you have fibrocystic breasts, breast self-exams are more challenging. Having fibrocystic breasts doesn't make you more likely to develop breast cancer, but it makes it harder to know what's normal and what's cause for concern. Becoming as familiar with your breasts as possible gives you the best chance of realizing when a lump or area of thickening might need further evaluation.

Pros and cons of breast self-exams

Breast self-exams alone don't reduce the number of deaths from breast cancer. However, if you combine breast self-exams with clinical breast exams and mammography, you can reduce your risk of dying of breast cancer.

One benefit of breast self-exams lies in the potential to identify and treat a cancerous breast lump while it's still small and in an early stage of development. Early detection of breast cancer leads to the best chances of beating the disease. On the flip side, however, is that you might need a biopsy to evaluate the area of concern. If the biopsy results are noncancerous (benign), you might feel that the biopsy was unnecessary — but at least you'll know that you don't have cancer.

Know that breast self-exams can miss tumors, as can other methods of screening. That's why it's important to rely on more than one method to screen for breast cancer. Regular clinical breast exams and yearly mammograms — in conjunction with breast self-exams — not only increase your breast familiarity, but may just save your life.