Breast Self-Examination

A breast self-examination (BSE) involves checking your breasts to help detect breast problems or changes. Many breast problems are first discovered by women themselves, often by accident. Breast lumps can be noncancerous (benign) or cancerous (malignant). Breast cancer can occur at any age, though it is most common in women older than 50.

Medical experts disagree about the need for regular breast self-examinations. A large study showed that regular breast self-examinations led to more doctor visits but did not find breast cancer earlier than regular medical examinations.¹ The U.S. Preventive Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care (CTFPHC) found no evidence that BSE saves lives, and they do not recommend routine breast self-examinations.^{2, 3} The American Cancer Society considers breast self-examination an option for women. Talk with your health professional about breast self-examination.

A breast self-examination involves checking your breasts for lumps or changes while standing and lying in different positions and while looking at your breasts in a mirror to note any changes in their appearance. Once you know what your breasts normally look and feel like, any new lump or change in appearance should be evaluated by a health professional. Most breast problems or changes are not because of cancer.

If you choose to do breast self-examinations, this should not replace regular clinical breast examinations (CBE) by a health professional and mammograms if you are older than age 40. Breast implants do not decrease a woman's risk for breast cancer, so women with breast implants need to talk with their health professionals about performing breast self-examinations.

A breast self-examination is done to detect breast problems, such as a lump or change in appearance, that may indicate breast cancer or other breast conditions that may require medical attention (such as mastitis or a fibroadenoma).

No special preparation is needed before having this test.

It takes practice to perform a thorough breast self-examination. Ask your health professional for tips that can help you perform a breast self-examination correctly.

The best time to examine your breasts is usually one week after your menstrual period begins, when your breast tissue is least likely to be swollen or tender. If your menstrual cycle is irregular, or if you have stopped menstruating due to menopause or the removal of your uterus (hysterectomy), do your examination on a day of the month that's easy to remember. Women who are pregnant or breast-feeding can continue to examine their breasts every month. Breast-feeding mothers can examine their breasts after a feeding or after using a breast pump so that the breasts have as little milk as possible, making the examination easier and more comfortable.

To do a breast self-examination, remove all your clothes above the waist and lie down. The examination is done while lying down so your breast tissue spreads evenly over your chest wall and is as thin as possible, making it much easier to feel all your breast tissue.

Use the pads of the three middle fingers of your left hand—not your fingertips—to check your right breast. Move your fingers slowly in small coin-sized circles.

Use three different levels of pressure to feel of all your breast tissue. Light pressure is needed to feel the tissue close to the skin surface. Medium pressure is used to feel a little deeper, and firm pressure is used to feel your tissue close to your breastbone and ribs. A firm ridge in the lower curve of each breast is normal. Use each pressure level to feel your breast tissue before moving on to the next spot.

Check your entire breast using a lengthwise strip pattern. Feel all of the tissue from the collarbone to the bra line and from the armpit to the breastbone. Start in the armpit and work down to the bottom of the bra line. Move one finger-width toward the middle and work up to the collarbone. Repeat until you have covered the entire breast. Repeat this procedure for your left breast. See an illustration of BSE using a lengthwise strip pattern. The American Cancer Society prefers this method of breast self-examination because it is the best method for finding breast lumps.⁴

You also can examine your breasts using a spiral pattern. Again, use three different levels of pressure to examine all your breast tissue. Avoid lifting your fingers away from the skin as you feel for lumps, unusual thicknesses, or changes of any kind. See an illustration of BSE using a spiral pattern.

Most breast tissue has some lumps or thick tissue. When in doubt about a particular lump, check your other breast. If you find the same kind of lump in the same area on the other breast, both breasts are probably normal. Pay attention to any lump that feels much harder than the rest of your breast.

If you find anything that concerns you, schedule a visit with your health professional. The important thing is to learn what is normal for you and to report any changes to your health professional. Remember that most changes you find are not breast cancer but should be checked. These changes may include:

• Any new lump. It may or may not be painful to touch.
• Unusual thick areas.
• Sticky or bloody discharge from your nipples.
• Any changes in the skin of your breasts or nipples, such as puckering or dimpling.
• An unusual increase in the size of one breast.
• One breast unusually lower than the other.

In addition to examining your breasts while lying down, you may also check them while in the shower. Soapy fingers slide easily across the breast and may increase your chances of detecting a change. While standing in a shower, place one arm over your head and lightly soap your breast on that side. Then, using the flat surface of your fingers—not the fingertips—gently move your hand over your breast (in the strip pattern described above), feeling carefully for any lumps or thickened areas.

A breast self-examination normally does not cause any discomfort. If your breasts are tender because your menstrual period is about to begin, a BSE may cause slight discomfort when you press on your breasts to feel for lumps.

The risk of doing breast self-examination is that you find a breast change that makes you anxious and may lead to a biopsy but turns out not to be cancer.

A breast self-examination (BSE) involves checking your breasts to help detect breast problems or changes.

If you find a lump or other unusual change, make an appointment with your health professional to have it checked. Be prepared to describe whether the lump is hard or soft and whether it moves easily under the skin. If your health professional does a clinical breast examination (CBE), he or she may recommend that you watch for changes and reexamine the breast in several weeks, sometimes waiting until after your next menstrual cycle. Further testing, such as a mammogram, a breast biopsy, or an attempt to remove fluid from inside (aspirate) the lump, may also be done. The lump is a cyst if the fluid inside is not bloody and if the lump disappears after aspiration.

Reasons why the results may not be helpful include:

• Changes in your breasts or breast tenderness that occur during your menstrual cycle.
• Examining your breasts at different times in your menstrual cycle. This may make it difficult to compare results of one examination with those of another.
• Having fibrocystic lumps. These may make a breast self-examination difficult because lumps occur throughout the breast. The fibrocystic lumps can also become tender before your menstrual cycle.

• Medical experts disagree about the need for regular breast self-examinations. The U.S. Preventive Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care (CTFPHC) found no evidence that BSE saves lives, and they do not recommend routine breast self-examinations. Some health professionals recommend regular BSE. A study has shown that BSE does not help detect breast cancer earlier.^{2, 3}
• An apparently normal breast self-examination does not rule out breast cancer. Breast self-examinations should not replace regular clinical breast examinations by a health professional and mammograms for women older than age 40. For more information, see the medical tests Clinical Breast Examination and Mammogram.
• Some women prefer to have regular breast examinations performed by their partner. As long as your partner is familiar with the normal look and feel of your breasts, any changes are likely to be found early.
• If you have a breast lump that you are concerned about, see your health professional to determine the cause. Remember, most breast lumps are not caused by cancer. A breast biopsy may be needed to fully evaluate a breast lump. For more information, see the medical test Breast Biopsy.
• A pad, the breast self-examination (BSE) pad, has been approved by the U.S. Food and Drug Administration (FDA) for use as an aid in breast self-examination. The sensor pad is made of two layers of plastic with a small amount of liquid silicone inside. It is supposed to make breast lumps easier to detect by reducing the amount of rubbing (friction) between the fingers and the breast skin. The sensor pad is available without a prescription at many pharmacies.

Citations

1. Thomas DB, et al. (2002). Randomized trial of breast self-examination in Shanghai: Final results. Journal of the National Cancer Institute, 94(19): 1445–1457.

2. Mahon SM (2003). Evidence-based practice: Recommendations for the early detection of breast cancer. Clinical Journal of Oncology Nursing, 7(6): 693–696.

3. U.S. Preventive Services Task Force (2002). Screening for breast cancer: Recommendations and rationale. Annals of Internal Medicine, 137(5, part 1): 344–346.

4. American Cancer Society (2004). Can breast cancer be found early? Detailed guide: Breast cancer. Cancer Reference Information. Available online: http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_breast_cancer_be_found_early_5.asp?sitearea=.