How and When to do a Self Breast Exam
Oct 04, 2023
Written By: Colleen McElroy, RN, FNP-BC
Happy October! Let’s get to know your breasts!
What is a self breast exam and who should do it?
A self breast exam is done to help detect breast cancer in the higher than average risk person. It is a task that can be done by yourself in the comfort of home. You may read or hear about the recent recommendations from experts reporting that self breast exams do not decrease the chance of mortality from breast cancer. These recommendations are based on data from well-recognized research studies and based on your risk factors, it is sufficient for you to have a breast exam in the office depending on your risk and age or to continue with your regularly scheduled mammograms.
Organizations like American Cancer Society and the American College of Obstetricians and Gynecologists recommend that if you are at higher than average risk for breast cancer, you should be familiar with what your breasts look and feel like. This is referred to as breast “self awareness”. Otherwise, mammogram screening or clinical screening in the office by your provider is sufficient in the detection of breast cancer in the average person due to the potential for false-positive results otherwise (you find something that you think is concerning and it leads to unnecessary tests) and lack of evidence for benefit of early detection and prevention.
Let’s peek at the risk factors. The American College of Obstetricians and Gynecologists describe risk factors for breast cancer as the following:
I do meet some of these risk factors, so now what do I do?
Self breast exam or breast self awareness is exactly as it sounds - you are feeling your own breast (“examining”) for abnormalities including hard immobile lumps, pain, drainage, or skin changes. It should be completed on a regular basis. I recommend marking a date on your calendar to complete the exam monthly (some birth control packets even have reminders on them for self breast exams). A good way to start is scheduling a self breast exam on your calendar for the day after the last day of your period, when the breasts are not tender and there is less likelihood for tendency to detect harmless cysts that may increase in size related to our hormones that regulate our menstrual cycles. Self breast exams are a great way to be involved in your health care and advocate for yourself in the office of your provider as well when you are at higher risk for breast cancer. As always, it is important to bring up any concerns with your self breast exam to your provider during a visit, so let’s discuss what signs we’re looking for here and how to complete a self breast exam.
How to complete a self breast exam?
Start by looking in the mirror in a seated (or standing) position with your hands on your hips. Look at the breasts for symmetry, obvious lumps, or skin discolorations. It is normal for women to have different sized breasts, different sized and shaped areolas/nipples from others and that’s what makes our bodies our own. It is important to look at your breasts and know YOUR “normals”. Abnormalities that should be brought to the attention of a medical provider include things like dimpling of the breasts, leaking from the nipples (when not breastfeeding or pregnant), inverted nipple, or skin discolorations (redness, tenderness, rashes). I will include some (easily Googled) graphic examples here.
When you’ve finished observing the breasts, begin to feel them in an organized fashion. Some people prefer to start at the armpit (lymph nodes and our breast tissue goes up into this area), and some decide to begin at the nipple or side of the breast. Wherever you choose to begin, just be sure you’re covering the entire breast. Here’s a picture of the anatomy of the breast to get a good understanding of where we should be feeling. Those green circles are lymph nodes, which can enlarge if there is an infectious or cancerous issue in the body.
Feel the breast with your fingertips, sliding them across the surface of the skin and applying gentle pressure so you can feel if there is a lump or bump beneath. You can go in a circle, side to side, or up and down - so long as you're covering the entirety of breast tissue. It can be completed sitting, standing, or laying down. If you complete it in a certain position one month, stick to this position for the future months!
What do I do if I find something?
First things first, make an appointment with a medical professional to assess what you’ve found. This will not only give you peace of mind, but it can help guide further recommendations including imaging or invasive investigation like a need for a biopsy. These are things you and your provider can decide together. Mainly, it is important to work with your trusted medical provider for individualized care. It is equally as important that you know the risk factors for breast cancer and allow that to guide your approach in your breast care and need for particular screenings. Talk with your provider about self breast exam recommendations and mammogram recommendations based on your age and risk.
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