Breast self-examination

Starting at about age 20, you should examine your breasts every month so you become familiar with their structure, enabling you to detect any changes, such as lumps, that might indicate breast cancer. Most lumps are found by women themselves.

When to do it
Premenstrual changes can cause temporary thickening that disappears after the period, so it is best to do breast self-examination (BSE) about a week after your period ends. Your breasts are also least likely to be tender or swollen then. If you are no longer menstruating, do BSE monthly, on the same day every month. If you are taking hormones, ask your doctor about when to do BSE.

Performing BSE

Step one:
Stand in front of a mirror and check the appearance of each breast for anything unusual. Check the skin for puckering, dimpling, or scaliness.

Do steps 2 and 3 to check for changes in breast shape or contour:

Step two:
Watching in the mirror, clasp your hands behind your head and press them forward.

Step three:
Press your hands on your hips and bend towards the mirror as you pull your shoulders and elbows forward.

Step four:
Squeeze each nipple gently and check for discharge.

Step five:
Raise one arm, and put it behind your head. Use the sensitive pads of the middle three fingers of your other hand to check the breast and the surrounding area thoroughly by feeling for any unusual mass under the skin. Repeat this procedure for the other breast.

Powder, oil or lotion can make it easier for fingers to move over the skin. You may want to do the standing part of the BSE in the shower. Your fingers move easily over wet, soapy skin, so you can concentrate on feeling for changes underneath.

Feel the tissue by pressing your fingers in small, overlapping areas. To be sure you cover the whole breast, be methodical and follow a definite pattern - whichever you find easiest:

  • Lines: Start in the underarm area and move your fingers gradually downward until they are below the breast. Then move them slightly toward the middle, and slowly move back up. Go up and down until you cover the whole area.
  • Circles: Beginning at the outer edge of the breast, move your fingers slowly around the breast in a circle. Move around the breast in increasingly smaller circles, gradually working towards the nipple.
  • Wedges: Starting at the outer edge of the breast, move your fingers towards the nipple and back to the edge. Check your whole breast, covering one small wedge-shaped section at a time.

Check the entire breast area in the same way each time you perform BSE.

A firm ridge in the lower curve of each breast is normal. Press firmly enough to feel different tissues, using three different pressures. First, light pressure to just move the skin; then medium pressure midway into the tissue; and firm pressure to probe more deeply - to the point just short of discomfort.

Feel the entire breast and chest area under your armpit, and up to the collarbone and all the way to your shoulder. The standing position makes it easier to check the upper and outer part of the breasts (towards the armpit), where about half of breast cancers are found.

Step six:
Repeat step 5 while lying down. Lie flat on your back, with your right arm behind your head and a pillow or folded towel under the right shoulder. This position flattens the breast and makes it easier to check. Check the right breast and the area around it with your left hand, using one of the patterns described above. Then examine your left breast using the same method, checking with your right hand, and placing a pillow under your left shoulder.

When to call the doctor
If you find any lumps, thickenings or changes, tell your doctor immediately.

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