Before you visit
Even before you make an appointment with your doctor, breast self-examination (BSE) should be part of your everyday routine. A BSE is a procedure a woman can do to physically and visually examine her breasts and underarm areas for changes. It should be noted that BSEs alone cannot accurately determine the presence of breast cancer. Therefore, if you choose to do a BSE, it should not be used in place of, but in addition to, a clinical breast examination performed by a health care provider and mammography. Women in their 20s and 30s should have a breast exam every three years, and women ages 40 and older should have a breast exam every year.
By doing BSEs regularly, you get to know how your breasts normally feel and look so that you are able to detect any changes more easily. Women can begin practicing BSE at about age 20 and continue the practice throughout their lives — even during pregnancy, after menopause and with breast implants. Breast self-examination should be performed every month. Become familiar with how your breasts usually look and feel so that you may notice any change from what is normal for you. If you still menstruate, the best time to do BSE is when your breasts are least likely to be tender or swollen, such as a few days after your period ends. If you no longer menstruate, pick a certain day — such as the first day of each month — to remind yourself to do your BSE. If you are taking hormones, talk with your health care provider about when to do your BSE.
Check with your health care provider if you find any change in your breast(s) that causes you concern, such as:
- Development of a lump
- A discharge other than breast milk
- Swelling of the breast
- Skin irritation or dimpling
- Nipple abnormalities (such as pain, redness, scaliness, or turning inward)
How to do a BSE
1. Stand in front of a mirror that is large enough for you to see your breasts clearly. Check each breast for anything unusual. Check the skin for puckering, dimpling, or scaliness. Look for a discharge from the nipples.
2. Watching closely in the mirror, clasp your hands behind your head and press your hands forward. You should feel your chest muscles tighten. Check for any change in the shape or contour of your breasts.
3. Press your hands firmly on your hips and bend slightly toward the mirror as you pull your shoulders and elbows forward. Check again for any changes.
4. Gently squeeze each nipple and look for a discharge.
5. Lie flat on your back, with one arm over your head and a pillow or folded towel under the shoulder. This position flattens the breast and makes it easier to check. The breasts are best examined while lying down because it spreads the breast tissue evenly over the chest.
6. Use the pads of the fingers of your other hand to check the breast and the surrounding area firmly, carefully, and thoroughly. Some women like to use lotion or powder to help their fingers glide easily over the skin. Feel for any unusual lump or mass under the skin. Feel the tissue by pressing your fingers in small, overlapping areas about the size of a dime. To be sure you cover the whole breast, take your time and follow a definite pattern: lines, circles, or wedges. Check the area above the breast, up to the collarbone, and all the way over to your shoulder.
Some research suggests that many women do a BSE more thoroughly when they use a pattern of up-and-down lines or stripes. The important thing is to cover the whole breast and pay special attention to the area between the breast and the underarm, including the underarm itself.
Consider using one of these patterns:
- Lines - Start in the underarm area and move your fingers downward little by little until they are below the breast. Then move your fingers slightly toward the middle and slowly move back up. Go up and down until you cover the whole area.
- Circles - Beginning at the outer edge of your breast, move your fingers slowly around the whole breast in a circle. Move around the breast in smaller and smaller circles, gradually working toward the nipple. Don't forget to check the underarm and upper chest areas.
- Wedges - Starting at the outer edge of the breast, move your fingers toward the nipple and back to the edge. Check your whole breast, covering one small, wedge-shaped section at a time. Be sure to check the underarm area and the upper chest.
The American Cancer Society recommends using three different levels of pressure to examine your breasts:
- Light pressure — to examine the tissue closest to the skin
- Medium pressure — to feel a little deeper
- Firm pressure — to feel deeper tissue closer to the chest wall
6. If you like, repeat step 5 in the shower. Your fingers will glide easily over soapy skin, so you can focus on feeling for changes underneath.
What if you find a lump?
One of the most frightening moments for a woman is seeing or feeling something different or unusual while performing breast self-examination. It is important to do regular breast self-examination so that you know what is normal for your breasts. If you find a lump, do not panic. It is natural to be frightened, but do not let the prospect of cancer keep you from taking action.
If you discover lumpiness in one breast or feel something "different" in the tissue, contact a health care provider. Sometimes, the lumpiness may be due to menstrual changes, but if you have nipple discharge or skin changes such as dimpling or puckering, your health care provider may want to see you right away.