All your questions about breast self-examination, answered!

Every woman has a lifetime risk of developing breast cancer, which is why breast self-examination should be performed regularly. The best way to determine what is normal for you is to become familiar with your breasts as every woman is uniquely different. Breast self-exam is a convenient, no-cost tool that you can use on a regular basis and at any age. It should be known that left and right breasts will not exactly match—few women’s breasts do, hence it’s very important to know the difference.

By examining your breasts regularly every month, you will know how your breasts normally feel & look. If a change should happen in your breasts, you will be able to identify it and consult your doctor.

When should I examine my breast?

Monthly breast self-examination should start in your 20’s and should continue regularly for your lifetime.

Check your breasts about one week after your period when your breasts are least likely to be swollen and tender.

If you have gone through menopause, if you are pregnant or if you have irregular menstrual cycles, do your examination on the same day of the month. Choose a day that's easy to remember, such as the first or last day of the month.

There’s no way to prevent breast cancer. However, there are steps you can take to detect breast cancer early when it’s most treatable. One of these steps is to perform a breast self-examination each month.

How do I examine my breasts?

Step 1: Start by looking for differences between your breasts

Good breast self-examination should be concerned with both the look and feel of breasts. The first step should be performed while either standing or sitting in front of a mirror, shirtless and braless with your arms at your sides. Examine both breasts and look for:

· Visible lumps.

· Changes in size, shape, contour and symmetry.

· Any unusual differences between the two breasts.

· Dimpling, puckering or indentations in the breast tissue.

· Redness, scaliness, or other changes to the skin or nipples that appear abnormal.

· Changes in your nipples, for example a nipple that is newly inverted or pulled in.

· Look for ridges along the bottom of breasts to see they are symmetrical.

Step 2: Put your hands on your hips and pull your elbows forward

Examine your breasts for the changes outlined in step 1 but this time with your hands resting on your hips while squeezing your elbows forward since this might bring out lumps that might not appear otherwise. Keep your hands on your hips and slowly turn from side to side to catch possible abnormalities from more angles.

Step 3: Put your hands above your head

Lift your arms above your head to see if there’s any puckering or dimpling of the skin when you elevate them. When you raise your arms, the mass, if there is one, stays there and the skin is pulled.

If you have a vision impairment that makes it difficult for you to visually inspect your breasts, you can ask a trusted friend or a family member to help you.

Step 4: Use 3 fingers when examining your breasts

Common ways to perform the physical part of the breast exam include:

- Lying down: choose a bed or other flat surface to lie down on your back. When lying down, breast tissue spreads out, making it thinner and easier to feel.

- In the shower: Lather your fingers and breasts with soap to help your fingers glide more smoothly over your skin.

When examining your breasts, some general tips to keep in mind include:

- Use three fingers, (index, middle and ring finger) rather than just one, which helps you from mistaking normal breast tissue for lumps.

- Use the pads of your fingers not the tips.

- If you have difficulty feeling with your finger pads, use another part of your hand that is more sensitive, such as your palm or the backs of your fingers.

- Use different pressure levels. Your goal is to feel different depths of the breast by using different levels of pressure to feel all the breast tissue. Use light pressure to feel the tissue closest to the skin, medium pressure to feel a little deeper, and firm pressure to feel the tissue closest to the chest and ribs. Be sure to use each pressure level before moving on to the next spot. If you're not sure how hard to press, talk with your doctor.

- Take your time. Don't rush. It may take several minutes to carefully examine your breasts.

- Follow a pattern. Use a methodical technique to ensure you examine your entire breast. For instance, imagine the face of a clock over your breast or the slices of a pie. Begin near your collarbone and examine that section, moving your fingers toward your nipple. Then move your fingers to the next section. Or you can do it in circular pattern starting around nipple and then spreading out to the entire breast or from outer side towards the nipple.

- Make sure not to skip any areas of the breast, whichever method you use.

- If you have a disability that makes it difficult to examine your breasts using this technique, you likely can still conduct a breast self-exam. Ask your doctor to show you ways you can examine your breasts.

Step 5: Examine your nipples

Bleeding and other discharges from the nipple should also be checked. To do so, squeeze the nipple gently to find out if there is bleeding or any discharge.

Step 6: Examine the areas surrounding the breast

After examining your breasts, it is important to perform a check of the areas around them. Continue to use circular motions and increase pressure as you move from the collarbone to the sternum and down below the breast.

Breast tissue extends up into your underarms, so it is important to be aware of this when doing your monthly breast self-examination. Underarm area is also the location of the nearest lymph nodes to your breasts and would be the first place, breast cancer would spread to if it were present.

With a relaxed arm by your side, check all the way into your underarm.

It is important to keep your muscles relaxed in order to feel deeply into this underarm space. Many people make the mistake of examining this area with their arm over their head. This is a problem because it naturally causes those muscles to become firm, inhibiting a proper exam.

If you find any deviation from normal, tell your doctor right away. Most breast lumps are not cancer, but you don't know if you don't ask your doctor.

What if I find a lump?

Do not panic. 80% of lumps are not dangerous. Still, it is important to visit your doctor for further evaluation and their recommendation about the next steps.

Many women find lumps or changes in their breasts, some of these changes occur at various points in the menstrual cycles.

Breasts often feel different in different places. For instance a firm ridge along the bottom of each breast is normal. The look and feel of your breasts will change as you age. There are a number of possible causes of non-cancerous breast lumps, including normal hormonal changes.

Finding a lump is the first step. What you do after finding it is the most important thing. Do not:

- Take the opinion of friends or relatives who had a nodule or a lump which disappeared on it's own.

- Self-medicate

- Go in for the wrong diagnostic test (A mammogram in a 20 year old could report normal even when she has a lump)

- Give yourself a clean chit of health because it is not paining, and you do not see any other symptoms that are ‘generally’ associated with a malignancy.

Don't try to diagnose yourself at home. Consult a specialist no matter how trivial the symptoms are!!!!

When should I contact a doctor?

Make an appointment with your doctor if you notice:

- A hard lump or knot near your underarm and breast.

- Changes in the way your breasts look or feel, including thickening or prominent fullness that is different from the surrounding tissue.

- Dimples, puckers, bulges or ridges on the skin of your breast.

- A recent change in a nipple to become pushed in (inverted) instead of sticking out.

- Redness, warmth, swelling or pain.

- Itching, scales, sores or rashes.

- Bloody nipple discharge

What to expect when I visit my doctor?

At an appointment to evaluate a breast lump, your doctor will take a health & family history, menstrual history, obstetric history and perform a physical examination of the breast and will most likely prescribe breast imaging tests.

Ultrasound is often the first or only imaging test used to evaluate a lump in women who are under age 30 or are pregnant or breastfeeding. Both an ultrasound and a mammogram are typically recommended to evaluate a lump in women who are over age 30 and not pregnant or breastfeeding.

If further testing is needed, your doctor may recommend additional imaging with MRI and/or a biopsy. They may also refer you to a breast specialist (typically, a breast surgeon) for further evaluation.

Breast cancer may be successfully treated if detected early. Get breast aware!