Breast Self Exam
Breast awareness and self exam
Beginning in their 20s, women should be told about the benefits and
limitations of breast self-exam (BSE). Women should know how their
breasts normally look and feel and report any new breast changes to a
health professional as soon as they are found. Finding a breast change
does not necessarily mean there is a cancer.
A woman can notice changes by being aware of how her breasts normally
look and feel and by feeling her breasts for changes (breast
awareness), or by choosing to use a step-by-step approach (see below)
and using a specific schedule to examine her breasts.
If you choose to do BSE, the information below is a step-by-step
approach for the exam. The best time for a woman to examine her breasts
is when the breasts are not tender or swollen. Women who examine their
breasts should have their technique reviewed during their periodic
health exams by their health care professional.
Women with breast implants can do BSE, too. It may be helpful to have
the surgeon help identify the edges of the implant so that you know
what you are feeling. There is some thought that the implants push out
the breast tissue and may actually make it easier to examine. Women who
are pregnant or breast-feeding can also choose to examine their breasts
regularly.
It is acceptable for women to choose not to do BSE or to do BSE once
in a while. Women who choose not to do BSE should still be aware of the
normal look and feel of their breasts and report any changes to their
doctor right away.
How to Examine Your Breasts
- Lie down and place your right arm behind your head. The exam
is done while lying down, not standing up. This is because when lying
down the breast tissue spreads evenly over the chest wall and is as thin
as possible, making it much easier to feel all the breast tissue.
- Use the finger pads of the 3 middle fingers on your left hand to
feel for lumps in the right breast. Use overlapping dime-sized circular
motions of the finger pads to feel the breast tissue.
- Use 3 different levels of pressure to feel all the breast
tissue. Light pressure is needed 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. It is normal to feel a firm ridge
in the lower curve of each breast, but you should tell your doctor if
you feel anything else out of the ordinary. If you're not sure how hard
to press, talk with your doctor or nurse. Use each pressure level to
feel the breast tissue before moving on to the next spot.
- Move around the breast in an up and down pattern starting at an
imaginary line drawn straight down your side from the underarm and
moving across the breast to the middle of the chest bone (sternum or
breastbone). Be sure to check the entire breast area going down until
you feel only ribs and up to the neck or collar bone (clavicle).
- There is some evidence to suggest that the up-and-down
pattern (sometimes called the vertical pattern) is the most effective
pattern for covering the entire breast, without missing any breast
tissue.
- Repeat the exam on your left breast, putting your left arm behind
your head and using the finger pads of your right hand to do the exam.
- While standing in front of a mirror with your hands pressing
firmly down on your hips, look at your breasts for any changes of size,
shape, contour, or dimpling, or redness or scaliness of the nipple or
breast skin. (The pressing down on the hips position contracts the chest
wall muscles and enhances any breast changes.)
- Examine each underarm while sitting up or standing and with your
arm only slightly raised so you can easily feel in this area. Raising
your arm straight up tightens the tissue in this area and makes it
harder to examine.
This procedure for doing breast self exam is different from
previous recommendations. These changes represent an extensive review of
the medical literature and input from an expert advisory group. There
is evidence that this position (lying down), the area felt, pattern of
coverage of the breast, and use of different amounts of pressure
increase a woman's ability to find abnormal areas.
