Many of us in the U.S. are aware that October is Breast Cancer Awareness Month, a time when we see pink ribbons raising awareness for those affected by breast cancer. Breast cancer is the second most common cancer for American women, with about 255,000 women getting the disease every year. Women over 50 are at a higher risk of contracting breast cancer, but women of any age can have the disease. In fact, 12,000 women under the age of 40 are diagnosed every year.

The good news? This type of cancer is easier to treat if it is detected in its early stages, which is why it is so important to perform a moderately regular self-exam either with a doctor or by yourself. In fact, Johns Hopkins Medical Center reports that roughly 40% of breast cancers are detected by women who discover their own lump. 

Benefits of a Breast Self-Exam

• Breast self-exams are a quick and convenient way to detect any abnormalities in the breasts.
• Self-exams help you get familiar with how your breasts usually look and feel, so you can become aware of what is normal for you during certain changes you go through regularly, such as menstruation or ovulation. Once you are familiar with your breasts, it can be easier to detect abnormalities.
• 40% of women who have breast cancer detected it through intentional self-exam.

Limitations of a Breast Self-Exam

• Mammograms or clinical examinations are more reliable than self-exams and can detect breast cancer before a lump forms. BSEs rely on the presence of a physical abnormality for awareness to be raised. Therefore, self-exams are not very effective at detecting very early-stage breast cancer.
• BSEs can be done improperly, which can result in an unreliable conclusion about breast health.
• Doing a breast exam to look for abnormalities can cause unnecessary stress and paranoia, leading to more unnecessary doctor visits.

It is important to note that breast self-exams are not replacements for mammograms, but they are a good way to stay informed about your breast health and detect abnormalities earlier than if not performed. If you are at high risk for breast cancer due to the disease running in your family, it’s important to get a mammogram annually. Women who have an average risk should get breast cancer screenings as needed at a young age, annually from ages 45 to 54, and every other year after age 55.

Breast Health 101: Common Questions About Self-Exams

At What Age Should I Start Breast Self-Exams and/or Getting Mammograms?

It's recommended that breast self-exams should begin at about age 20 for women, and it is best if they are done multiple times a year or monthly. Before age 40, it is recommended to schedule a clinical examination at least every three years. For women over 40, a monthly self-exam and annual clinical examination – that may include a mammogram – is recommended. Your primary care doctor or OB/GYN will be able to provide more personalized recommendations for you.

If you have been told you are at greater risk of developing breast cancer, it is recommended you complete self and clinical exams more often, and your doctor may start you on mammograms at a younger age, such as 30 or 35. Reasons you might be considered “higher risk” can include factors such as a family history of breast cancer, current age, obesity, or physical inactivity.

When Is the Best Time to Do a Breast Self-Exam?

The best time to do an exam is one week after your period starts, as this is when your breasts are least likely to be swollen or tender due to menstruation. Examining your breasts at other times during your monthly cycle can be difficult as soreness or tenderness may be present and make it more difficult to perform the exam.

What If I Feel a Lump or Notice an Abnormality?

Finding something concerning during a self-breast exam can be very stressful. Don’t panic; most women have some small lumps in their breasts that are benign. It is not abnormal at all to feel a couple of small lumps during your exam, but the more you perform the exam and your familiarity grows, you will be able to detect any abnormalities easily. Just because you found a lump, doesn’t mean it is breast cancer. However, it does mean that you should contact your doctor and make an appointment for a clinical breast exam.

If you do make an appointment, you should know what to expect. If you think you have found something concerning during your self-exam, your doctor will look at your health history and do a physical exam of the breast, as well as potentially ordering breast imaging tests such as a mammogram or an ultrasound.

Is Breast Pain Anything to Worry About?

There are several reasons you may be having breast pain that don’t include underlying diseases. In fact, breast pain or soreness is fairly common for women during menstruation, ovulation, or menopause. Make note of whether the breast pain is constant, if it comes and goes at different points during the month, and/or whether it is abnormal for you.

If the breast pain comes and goes, it is most frequently the result of hormonal changes that occur during your monthly cycle. Breast injury, issues with the chest wall, unsupportive bras, and breastfeeding can also be causes of breast pain. If the pain is continuous and uncomfortable, it’s best to discuss it with your doctor.

Do Breast Self-Exams Replace Clinical Exams?

No, they do not. BSE’s are a great way to remain aware of your own breast health, but it is important to remember that mammograms and clinical examinations are the best way to detect breast cancer. Getting clinical exams at the recommended interval of time is highly important to ensure you are informed about your own breast health.

How Can I Keep Track of My Breast Self-Exam?

The business of life can easily lead you to forget a breast exam, but there are ways you can include it into your schedule to make it easier to remember. Making a breast exam a part of self-care is one great way to remember to perform the exam.

Doing the exam in a bubble bath, or setting aside one night a month to pamper yourself and do a breast exam is a great way to ensure you are fitting it into your schedule. Setting a reminder on your phone can also help you remember.

Now that we've covered the most common questions about breast health, here is our guide for performing a better self-breast exam.

Follow These 4 Steps for an Effective Breast Self-Exam 

Below are our four steps to performing a better self-examination at home.

1. Look in the Mirror 

Start the breast self-exam by looking in the mirror at your breasts with your shoulders and back straight, and arms on the hips.

• Look at the size and shape of your breasts, and see if they are in their normal size, shape, and color.
• Look closely: are there any abnormalities visually?
• Look out for these visual signs that something may be wrong: dimpling, puckering or bulging of the skin on the breast, an inverted nipple or abnormal positioning of the nipple, any signs of rash, redness, or swelling.

2. Lift Your Arms

Raise your arms above your head while observing your breasts; notice if you see any abnormal visible changes in this position. Look for the same types of abnormalities listed above. Additionally, look for any signs of fluid coming out of one or both nipples. This fluid could be watery, milky, yellow in color, or bloody. If you notice any of these signs during the physical exam, make an appointment with your doctor.

3. Lie Down and Perform the Physical Exam

Next, lie down on a bed or couch and begin to use your hands to feel your breast. The goal of this step is to check for anything that strikes you as different or not your "normal." According to the Dana Farber Cancer Institute, a lump in your breast will feel firm, as opposed to the more spongy tissue of the breast. They are often irregularly shaped as opposed to a sphere or ball shape. Lumps may also be mobile and able to be moved around within the breast.

Use the opposite hand to examine each breast; for example, use your left hand to examine your right breast. Using a firm touch with three fingertips, perform a circular motion about the size of a quarter along the breast. Make sure you end up covering the entire breast, including the area from the collarbone to the top of your abdomen and from your armpit to your breasts. Our friends at Keep A Breast Foundation recommend spending extra time on your arm pits where your lymphatic system is, as this is where many breast cancers develop. 

Once you have done the circular motions on the whole area, you may choose to move your fingertips vertically up and down the area as well. It can be helpful to use massage oil or do the exam in the shower to make the process more comfortable and smooth.

Be sure to feel all the tissue from the front to the back of your breasts: for the area just beneath the breasts, use light pressure. Use medium pressure for tissue in the middle of your breasts near the nipple, and use firm pressure for the deep tissue in the back. 

4. Perform Physical Exam While Sitting Up

Lastly, go through the same process listed in step three on your breasts while sitting up.

Conclusion

Doing a breast self-exam can be a crucial aspect of maintaining breast health and awareness. Although it doesn’t replace a clinical examination, it is a great way to stay informed on your own body and give you some peace of mind.