Breast self-exams

A breast self-exam is a monthly evaluation you can do at home to check for changes in your breasts. During a breast self-exam, you may be able to detect puckering or dimpling of the skin, nipple discharge, redness or swelling, lumps or thickening, and changes in the size or shape of breast tissue.


Purpose
Breast self-exams are intended to detect breast lumps or other breast changes at an early stage. Because breast cancer is often characterized by physical changes of the breast and surrounding area, it's important to have any lump or change in your breast examined by a doctor. Most breast lumps are not cancerous, but cancerous lumps may be curable if detected at an early stage.

Indications
Every woman's breasts are unique. Many factors contribute to changes in breast tissue, including aging, the menstrual cycle, pregnancy, menopause, and taking birth control pills or other hormones. Breast self-exams are important for all women, including those who are pregnant or breastfeeding, have breast implants, or have gone through menopause. Doing a monthly breast self-exam will help you become familiar with your own breasts so you're better able to identify abnormal changes, should they occur.
Although some authorities recommend monthly breast self-exams, other experts consider them optional because they're not as sensitive as clinical breast exams (examination of your breasts by a health professional). Also, as you age, the less accurate self-exams become. A breast self-exam should never be considered a substitute for a clinical breast exam or mammography. However, the American Cancer Society and the American College of Obstetricians and Gynecologists continue to recommend monthly breast self-exams as a supplement to other screening techniques.

Some health care professionals recommend the following screening schedule:

After age 20, do a monthly breast self-exam.

Between ages 20 and 39, see your doctor for a breast exam every two to three years. Beginning at age 40, visit your doctor once a year. The U.S. Preventive Services Task Force concluded that there is insufficient evidence to recommmend for or against routine clinical breast examination alone to screen for breast cancer.

Get a baseline mammogram by age 40. Have screening mammograms every one to two years until age 49, and have an annual mammogram after age 50. The U.S. Preventive Services Task Force recommends mammograms every one to two years, with or without clinical breast examination, for women age 40 and older.
If you're at high risk for breast cancer, other screening recommendations may apply. Discuss the benefits and risks of routine screening, as well as any concerns, with your doctor. Together, determine an appropriate screening schedule.


Procedure
It's best to do the exam seven or eight days after your period ends, when your breasts aren't likely to be tender or swollen. If you've stopped menstruating, simply pick a day to do your exam and stick with it each month for easy remembrance.
Start by standing in front of the mirror with your arms at your sides. Look for any changes in the color or texture of the skin on your breasts, such as puckering or dimpling). Also note any changes in the size of either breast or the appearance of either nipple. Next, observe your breasts with your hands on your hips. Repeat the process with your hands raised over your head.

For the second part of the exam, place your left hand behind your head and your right hand on your left breast. (Some breast changes can be felt more easily when your skin is wet and soapy. If you prefer to do this part of the exam while showering, lather your hands with soap before beginning the exam.) Starting at the 12 o'clock position, move the fingerpads of your three middle fingers in tiny circular motions to feel for lumps. Keep your hand flat and your fingertips together. Once you're back to the 12 o'clock position, move your fingertips closer to the nipple and repeat the process. Continue until you've examined your entire breast, using varied amounts of pressure to feel both superficial and deep masses. Another common method is to start at the nipple and gradually move out to the sides of the breast. Don't forget to feel the area beside the breast and under your arm. Also, check for nipple discharge by gently squeezing the nipple between your thumb and forefinger. Next, using your left hand, examine your right breast the same way.

Next, lie on your back and place a pillow under your left shoulder. Put your left hand behind your head to distribute the breast tissue more evenly. With your right hand, examine your left breast just as you did in the shower. Again, check for nipple discharge. Next, place the pillow under your right shoulder and use your left hand to examine your right breast the same way.

For the final part of the exam, examine both armpits and your upper chest. Although less common spots for breast cancer to develop, these areas may be the first place you feel cancerous changes.

Remember, it's important to see your doctor right away if you detect any nipple discharge or changes in your breasts. Also, clearly understand your doctor's recommendations for professional exams and mammograms based on your age and breast cancer risk factors.


Considerations
Pay particularly close attention to the upper, outer part of your breast. About half of all cancerous lumps are detected in this area.
If you have fibrocystic breast changes, characterized by benign (noncancerous) breast lumps and breast pain, note the number, location and character of the lumps. This will make it easier to detect any changes. Though fibrocystic changes can make breast self-exams more difficult to interpret, the increased familiarity that develops with regular exams may help you detect changes. Diagnostic imaging techniques may be used to provide more detailed information about the lumps.


When to consult your doctor
Be sure to consult your doctor if you notice any of the following symptoms during a breast self-exam or at any other time:
a lump in your breast, armpit or upper chest
a newly inverted nipple (the nipple turns in)
nipple discharge, which may be bloody and from only one breast
nipple itching, scaliness or tenderness
thickened or dimpled breast skin
change in the size or shape of one breast
breast pain
any other unusual breast or nipple changes

Pregnancy-specific information
Hormone-induced changes related to pregnancy can cause many breast changes. For example, fibroadenomas (noncancerous lumps) often enlarge during pregnancy, and other changes can make it more difficult to detect lumps. Consult your doctor if you notice a lump or any other symptoms.

Senior-specific information
The risk of developing breast cancer increases with age, so continue breast self-exams at the same time each month. Also, be sure to see your doctor on a regular basis and schedule a mammogram every one to two years.