Breast Self-Exams & How to Do Them
Women today might remember laminated, breast self-exam instructions affixed to the mirror in the bathrooms of their mother or grandmother. Or is that just us?
Once a mainstay of breast cancer prevention and detection, the breast self-exam today isn't as much of a recommended practice as it was in its 1970s and 1980s heyday. But breast self-exams are still an important tool to understand and monitor the body — so when something changes, you can tell your doctor.
A very brief history of the breast self-exam
The push for breast self-exams started in the 1950s after the American Cancer Society and National Cancer Institute released the film "Breast Self-Examination," complete with educational materials that emphasized it was possible to find breast cancer early. In the 1970s, when the American Cancer Society began its early-detection recommendations for women without symptoms, a monthly breast self-exam was one of the first suggested tests.
But research completed in the 1980s and 1990s showed insufficient evidence for recommending breast self-exams. The American Cancer Society decreed such exams as optional in the late 1990s and dropped them from its recommendations in the early 2000s.
So is there value in breast self-exams?
"Self-breast exams are still very important, and they do work," says Dr. Esther Dubrovsky, a breast surgeon at Houston Methodist. "I can't tell you how many of my patients examine themselves and find their own cancer. That is what prompts them to get a mammogram."
"This is especially important for young women under the age of 40, who are not getting mammograms yet," adds Dr. Dubrovsky. "As for patients who get regular annual screening mammograms, they sometimes notice a mass months before they are due for their next mammogram. That mass sometimes ends up being a new cancer. I would never discourage anyone from examining their own body."
Who should do a breast self-exam?
Dr. Dubrovsky says that individuals can start breast self-exams around age 25 to get familiar with what is normal for your own breasts.
"We always tell patients to wait until their period is over — that's the perfect time to do a breast exam," Dr. Dubrovsky says. "That's when breast tissue is at its calmest. They're less tender, less nodular. They feel more normal right at the end of your period. It's important to know what your breasts feel like, so that you can be aware of a change."
The population that most needs to perform breast self-exams are individuals at higher risk for breast cancer, according to Dr. Dubrovsky. Individuals at higher risk are those who have previously had atypical cells found on biopsy and a family history of breast cancer. Other risk factors for breast cancer include extremely dense breasts, obesity and smoking.
"We want those at high risk to be doing breast exams, because if they notice something, it is better to come in right away. We don't want people to wait that full year for the next mammogram," Dr. Dubrovsky said.
How to do a breast-self exam
To perform a breast self-exam, you'll want to complete the following steps while both standing and lying down.
- Always use your opposite hand to check each breast — so use your right hand on your left breast and your left hand on your right breast.
- Make your hand flat, and use your fingers (from your middle knuckles to the fingertips) to complete a sweeping motion starting at your clavicle (collarbone) down toward the nipple with nice, firm pressure.
- Then sweep all the way around towards the nipple from the outside of the breast to the nipple.
- Check the areola, the ring of pigmented skin around the nipple.
"Just sweep from the clavicle down and then go all the way around, meaning from the bra line to the nipple, from the chest bone to the nipple with that same sweeping motion and then behind the nipple and areola itself," Dr. Dubrovsky says.
Good technique — making sure to keep your hand flat and using more than just your fingertips — improves your likelihood of spotting issues.
"The way I like to explain it is — imagine you were given a ball of dough with a single chocolate chip inside," Dr. Dubrovsky says. "The best way to find the chocolate chip is to take your whole hand and press down and sweep the dough, not to poke at it with just one finger. When you poke it with one finger, that chocolate chip just moves to the side. When performing a breast exam, don't poke with a finger. You really want to use the full flat part of all your fingers. Then it's much easier and much quicker to feel a lump."
There is a learning curve to breast self-exams
Part of the process of completing breast self-exams is simply getting to know your breasts. As you continue doing self-exams month after month, you'll start to encounter what feels normal for you. And it's OK if that baseline normal might be a little dense, or even lumpy.
"It's very common for people to not know what to feel for," Dr. Dubrovsky says. "That is why it is important for women to familiarize themselves with their breasts. Yes, it is lumpy and bumpy, and there are densities. But if you are used to your own lumps and bumps, then you are more likely to notice if there's a new mass."
Dr. Dubrovsky says it's normal to have dense tissue. Frequently, the upper outer quadrant of the breasts (near the armpit) has dense tissue. In some women, the entire breast can be dense.
"It can feel like this massive lump on both sides, but you notice that it gets tender every month and that it kind of swells, but then it gets better right after your period," she says. "That's totally normal."
Breast self-exams are not a substitute for mammogram
Mammogram remains the gold standard for finding breast cancer. Women at average risk for breast cancer should begin getting an annual screening mammogram at age 40. If you're at higher risk for breast cancer, you may have to start getting mammograms before age 40.
"Just because a self-exam is normal doesn't mean that there isn't breast cancer," Dr. Dubrovsky says. "Not all breast cancers are palpable, meaning we can't always feel them. Breast cancers can hide inside the breast. So mammograms are extremely important."
Getting a yearly mammogram is your best bet to find cancer early. Performing a monthly breast self-exam is an extra safeguard that may help you notice something abnormal and get it checked out before your next mammogram.
"Since mammograms are only done once a year, a breast cancer can develop in the interim," Dr. Dubrovsky says. "A self-exam might help you catch cancer months ahead of your next mammogram. Catching a breast cancer a few months early could make a big difference."
Signs to call your doctor about
When completing a self-exam, you're looking for lumps. But there are other breast changes that should prompt you to ask your doctor for a diagnostic mammogram. These can include:
- Nipple or areola shifting or changing size
- Inverted, or sunken nipple
- Dimpling of skin
- Bloody nipple discharge
- Thickening or redness of the skin
- Discoloration of the areola or nipple
Taking time every month to look at your body can help you stay connected with what's going on with your health.
"Breast self-exams are still very important," Dr. Dubrovsky says. "We should all be familiar with our own bodies. We should all notice and let our doctors know if something feels different."
August 16, 2023