There is no right or wrong way to perform a self-breast exam; the key is to be consistent. Although there is no consensus on the usefulness of the self-breast exam, I have seen numerous cases where a new cancer is first felt by the patient. Therefore, we encourage all women to perform this exam monthly. Annual breast examinations should also be performed by your primary care provider (PCP).
In breast imaging, the goal is to find cancer before it grows to a size where the patient or PCP may feel it. When women are consistent with annual screening mammography, this is often the case. Cancers that are less than 1 cm in size when diagnosed are known to have a 95% 5-year survival rate. However there are cases where the developing cancer is palpable (can be felt by you or your PCP) but is hidden by dense breast tissue on the mammogram, the cancer is more aggressive and grows to the point where you can feel it within the year between screening mammograms, or cancer is growing and screening mammography is not performed consistently every year. In these cases, feeling a lump on the self-breast exam may be the first indication that there is cancer.
Although we evaluate all new lumps in the breast with equal attention, you should understand that not all lumps in the breast are breast cancer. In fact, most women who are sent for diagnostic imaging of a lump in the breast do not have breast cancer.
The breast tissue is made up of two different types of tissue: fatty tissue and glandular tissue. Often women who are feeling lumps in the breast are actually feeling the interface between these two types of tissue. If there is an area in the breast with a higher concentration of glandular tissue, this will feel different, sometimes even mass-like, when compared to the rest of the breast where fatty tissue predominates. Hormonal stimulation of the breast tissue often exaggerates the lumpy feeling of the glandular tissue. This may occur during the menstrual cycle, perimenopause, and with hormonal therapy. Other non-cancerous lumps felt in the breast include a fluid-filled cyst, a fibrous benign tumor (fibroadenoma), or a fatty benign tumor (lipoma).
Most women have some lumpy bumpies when they feel their breast tissue; the key is to be comfortable with what is normal for you. If you are comfortable with your normal variations in breast tissue, then you will feel more confident when a change occurs. This should prompt you to seek medical attention via your PCP, who will then likely send you for diagnostic breast imaging.
Let’s now discuss the mechanics of the self-breast exam and what you are looking for during the exam.
When to perform the self-breast exam:
- Pre-menopause: the self-breast exam should be performed once a month in the week following your menstrual cycle. This is when the hormonal stimulation of the breast tissue is lowest, minimizing the natural lumpy bumpy feeling of your breast tissue.
- Post-menopausal women and women not menstruating due to a variety of reasons: pick a day of the month that is easily remembered so that you can consistently perform the exam monthly.
How to perform the self-breast exam:
- Prior to a shower, stand in front of the mirror with your hands on your hips.
- Look in the mirror for symmetry of the breasts, nipple retraction, skin dimpling, puckering, new skin rashes or color changes.
- Lean forward and watch for any dimpling or puckering in the skin with this movement.
- In the shower, lather up with soap. The breast exam can be performed any number of ways. We will describe two but the specific technique isn’t as important as being consistent in executing the exam so that you are confident that all areas of each breast have been examined. Enough pressure should be applied that you appreciate the differences in your breast tissue, but not so much that the pressure is painful.
- Start with one hand behind your head with your elbow out to the side.
- Begin in the armpit area (axilla)
- Option 1: move in a circular motion from the axilla around the breast. Each circle should move closer to the nipple until the entire breast has been examined. This would look like a spiral if you drew the motion on your breast.
- Option 2: move in a straight line from the axilla to the nipple and repeat the motion from the outer breast to the nipple until the entire breast has been examined. This would look like spokes on a wheel that are extremely close together if you drew the motion on your breast.
- Repeat on the opposite side.
- Feel for any NEW lumps in the breast. Any new lump should be evaluated by your PCP and with diagnostic imaging. The more suspicious lumps are hard and immobile.
- DO NOT squeeze the nipple to check for nipple discharge. Nipple discharge is discussed in more depth here.
If you perform this exam consistently, you will be much more comfortable with the normal variations in your breast tissue, allowing you to notice subtle changes earlier. Any new finding in your self-breast exam should be evaluated by your PCP, and likely with diagnostic breast imaging.