The Self-Breast Exam: An Important How-To

The American Cancer Society recommends women over the age of 40 get an annual mammogram to detect any evidence of breast cancer. However, a mammogram alone does not suffice when it comes to complete comprehensive breast cancer screening. Turns out, a simple self breast exam — one that you can do on your own time with your own two hands can provide comprehensive screening. And perhaps save your life one day.

The self-breast exam can detect masses that a mammogram cannot visualize. This can occur when the mass is able to ‘blend in’ with the fibro—fatty tissue of the breast—allowing it to appear as normal tissue on a mammogram. This is often the case in women with ‘dense breast tissue’. A mass is more difficult to detect and can easily ‘hide’ on a mammogram.

Additionally, there are areas in the breast that a mammogram simply cannot visualize. These tend to be higher up by the collar bone, down below where the breast meets the beginning of your abdominal muscles, near your sternum, and high up in your armpit or ‘axilla’.

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How Do I Perform My Self Exam?

I recommend doing your exam standing up and lying down. This allows tissues to shift and creates a more accurate exam. The first step is a visual inspection of both breasts while standing up and looking straight into a mirror. Look for any skin changes (rashes), any skin dimpling, or any nipple inversion. Turn to each side and get a sideways view as well. Raise both arms up to see any changes in the outward appearance of your breasts.

While standing up, use your right hand to examine your left breast. To examine all of the tissue, start centrally by the nipple and work from the inside out. Palpate, or press firmly, on your tissue in small, overlapping areas; follow a circular pattern, starting inwards and moving out. Some women prefer to move up and down their breast pressing in a linear fashion. Continue to thoroughly and slowly examine each portion of the breast until you reach the collarbone and underside of your breast. Make sure to palpate throughout your armpit and up into collarbone as well. Repeat on the right side using your left hand. Once you have completed your standing exam, repeat the entire process lying down with each arm raised while you examine.

It is important to recognize what is normal vs. abnormal in your exam. Many women have fibrocystic breasts—they have many normal or ‘cystic’ masses throughout their breast tissue. Once you begin and continue your monthly exams, you will learn to recognize normal vs. abnormal results.

Your doctor will then perform a clinical breast exam and perhaps order imaging to complete his/her assessment.

How Often Should I Do My Self Breast Exam?

Self-breast exams should be done once a month at a consistent time each month. Pick a day you remember (like the first of the month) to easily establish a consistent monthly routine. If you are still having periods, avoid right before or during your cycle as this can make your exam more ‘lumpy’ than normal.

As a breast surgeon—I perform clinical breast exams on a routine basis and I educate patients to perform their self-breast exams monthly. I often see patients who say, “My breast are so lumpy—there is no point in even doing my own exams!” To those patients (often with fibrocystic breast disease), I say the self-exam is paramount. Only YOU can know your body best, therefore you will know when something has changed. It is critical to understand what feels normal in the event you ever find something abnormal during a self-breast exam. Knowledge is power and early detection is key.