Breast Self-Exam

Why do I need to examine my breasts?

Finding a tumor before the cancer has spread to other parts of your body can mean the difference between life and death. Women themselves first detect many breast cancers — and according to the American Cancer Society (ACS), women who are attuned to changes in their bodies are more likely to spot a suspicious lump. New guidelines issued by the ACS say that while monthly self-exams are less effective than first thought and are no longer emphasized; examining your breasts can help you stay in touch with what is normal for you. It is best to begin around age 20, so you can learn early on what your normal breast tissue feels like, but it is never too late to start. Even if you examine your breasts regularly, however, you should still have your doctor examine your breasts once a year.

If you choose to do breast self exam (BSE), the following information provides a step-by-step approach for the exam. It is acceptable for women to choose not to do BSE or to do BSE occasionally. Women who choose not to do BSE should still know how their breasts normally look and feel and report any changes to their doctor right away.

When is the best time to do the exam?

Examine your breasts at the same time each month. The best time is usually a few days after your period, when your breasts are least likely to be tender or swollen. If you no longer menstruate, pick a day that you can remember easily, like the first of the month.

How do I examine my breasts?

Some women hesitate to do a self-exam because they do not know what they are looking for. Generally, malignant lumps are firm, discrete and immobile. However, many malignant tumors do not fit this description, so any change you feel should be evaluated by a doctor. It is important to remember that the old saying, "if it hurts, it's not cancer" is not true. Also remember that if your mammogram is normal and you find a lump, you should still be seen by a doctor because not all lumps show up on mammograms.

One breast surgeon in the San Francisco Bay Area says her patients have lots of reasons for avoiding self-exams: they do not know how, their breasts are too lumpy, they do not have time, or they are too scared of finding something. Some doctors say that women should do whatever kind of exam they are comfortable with, as long as they get to know what their breasts feel like normally. Do not, in other words, set yourself up to do something so difficult and time-consuming that you do not do it at all. In that spirit, here are a few guidelines:

1.	Stand in front of a mirror with your arms at your sides. Look for any changes in the size, shape, or skin of your breasts, including dimples or scaly patches. Check for discharge. Any bloody discharge should be evaluated by a doctor right away.
2.	Clasp your hands behind your head and again look for changes in the size, shape and contours of your breasts. Then check again with your hands on your hips, bending slightly toward the mirror with your elbows and shoulders pressed forward.
3.	Do this next part lying on your back in bed, where you have better access to the undersides of your breasts. Lying down also spreads the breast evenly and thinly, making any abnormalities in the tissue easier to feel.
	With your left hand behind your head, use the fingertips of the three middle fingers of your right hand to feel for lumps under the skin of your left breast. Use small, overlapping, circular motions and start just below your left collarbone, pressing your fingers on a small area the size of a quarter. Using various amounts of pressure, feel both on the surface and deep in the breast tissue for lumps that differ from the overall consistency of the breast in any way. Make sure you cover everything from the collarbone to the bottom of the breast, and out to and including the armpit. Move around the breast in an up and down pattern (experts say this is the most complete and effective way to examine the entire breast). Switch hands and examine the right breast in the same way.

What should I do if I find a lump or change in my breast?

It is normal for breasts to have some lumps, or for one to be slightly larger or lower than the other. Ideally you will want to get to know every idiosyncratic lump and bump in your breasts, so you can recognize anything unusual. Suspicious lumps may be particularly hard to distinguish if your breasts contain fibroids or cysts, usually harmless masses that occur more frequently as you age. Searching for irregularities can be scary and frustrating, especially since doctors strongly recommend that you have anything suspicious checked out. Make an appointment with your doctor if you do come across something that seems atypical.