While most patients know they should be familiar with changes in their breast tissue, many are afraid that they will “do it wrong” and avoid doing self-exams altogether! I’d like to share some useful tips about when and how to do a self-exam.
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1. Do your breast exam at the same time each month
If you get menstrual periods, perform the exam the week afterward. This is when the breast tissue is the least lumpy. If you do not get periods, pick a day each month and stick to it.
Phone app reminders are a useful tool. Many women examine their breasts more often than once a month, but doing so can be like watching a small child grow. If you see them every day, you are less likely to notice their growth than if you see them less frequently. You may miss subtle changes if you are checking too often.
2. Stand in the mirror and examine your breasts
Stand in front of a mirror and note the size and shape of your breasts. It is common for one to be larger or smaller than the other. Note any nipple changes — nipple inversion on one or both sides is common. If you see new changes in the size or shape of one breast or in a nipple, report them to your health care provider.
“You want to use enough pressure to check all of the tissue between your skin and your ribs, but obviously not so much that it is painful.”
Next, lift your arms above your head. Note any dimples or lumps. Cancers can tug at the skin, nipples and muscles. If you notice anything different or asymmetric (on only one side), see your doctor.
3. Check for changes or lumps in your breasts
Now, lie on your back and lift one arm above your head. Lying down flattens and thins out your breast tissue, allowing for easier examination.
Using your other hand, reach across your chest and use the fat pads of your index and middle fingers (not the tips but the part of the finger that you use to type on a keyboard) to gently press your breast tissue against your rib cage. You want to use enough pressure to check all of the tissue between your skin and your ribs, but obviously not so much that it is painful.
Now, gently slide your fingers in circles, either from the outer breast to the nipple, from the nipple outward, or up and down across your chest. There is no “right way” as long as you cover the area up to your collarbone, across to your sternum or breast bone, and then laterally up into your armpit.
You are looking for a hard lump that is the consistency of a frozen vegetable, like a pea or lima bean. Lumpy areas are very common — try to become accustomed to what is normal for you. It is also very common to feel a thickening at the bottom part of the breast (where an underwire would sit on a bra), which is usually normal. When in doubt, have your doctor double-check. Finally, give your nipple a gentle squeeze.
Report any changes in the breast, skin or nipple, including nipple discharge, to your doctor. It is also important to report persistent pain in one area of the breast, as this can, rarely, be a sign of breast cancer.
4. Report changes in family history
Part of self breast awareness is knowing your family history and making sure that your doctor knows of any updates. Cancers that occur early (under the age of 50) and rare cancers such as ovarian cancer or pancreatic cancer are particularly important to report. Red flags may prompt referral to a genetic counselor.