How should I monitor my breast health?

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Dr. Amanda J. Morehouse, MD
Critical Care Surgeon

If you're pre-menopausal, the best time to do a breast self-exam is about a week after your period starts. That's when all of the hormonal fluctuations are going to be the most even. If you're post-menopausal, those hormonal fluctuations don't play any role so any time of the month is fine.

It’s important for everybody to be familiar with what's normal for them. Doing a self-exam monthly has not been shown to consistently improve a person’s ability to find something specific. But being cognizant and aware of how things feel and are normal and healthy for you is important. If someone finds a breast cancer on self-exam, they usually find it doing something routinely, like getting dressed or putting on lotion.

The best way to perform a breast self-exam is to do the following:

  • Go in circles, up and down through the breast, whatever is easier for you to be able to cover all of the breast tissue. Everyone's breast size is different so it may be a little different for any one person.
  • Cover the area from the clavicle all the way down to below the breast on the rib.
  • Cover from the breast bone in the middle, all the way over and including under the arm.
  • Inspect the breast. Stand in front of the mirror and make sure that the skin looks normal and the nipple looks normal.

It's important for you to talk with your healthcare provider to learn about your personal risk of developing breast cancer so that you can decide how to stay on top of your breast health. And don't forget periodic breast self-exams. Many women neglect doing these exams for fear of ending up in the doctor's office every month with a new lump and bump, but it's important that you get to know your breasts over time so you notice any changes.

Some women feel very comfortable taking a step-by-step approach to doing a monthly breast self-exam (BSE). Other women prefer to examine their breasts in a less systematic way, while they are showering or getting dressed, with an occasional, more thorough exam. As long as a woman monitors the look and feel of her breasts regularly, either technique is acceptable.

Women who examine their own breasts should keep in mind that breast changes can occur with pregnancy, aging, menopause, during menstrual cycles or when they are taking birth control pills or other hormones.

Women should start breast self-exams (BSE) at age 21, and should do it monthly; women can often spot subtle changes in their own breasts that doctors miss. Women should not look for lumps but should make a major attempt to obtain a mental image of their normal breasts. The process of obtaining the mental image of the normal takes time.

When learning the normal baseline, women must spend at least 15 minutes examining both breasts as done in my video. They should repeat the process every day until they are satisfied that they have a clear mental image of the normal. Once this level of confidence is reached, the exam should be done monthly.

Lying down is the preferred way to do BSE. By lying down and extending the arm, the breast is "thinned out," making it easier to detect subtle changes. For women who have regular menstrual periods, the exam should be done 5-10 days after the onset of her menstrual period. This is the time when the breasts are least tender and lumpy. Ideally, a women should start doing BSE after she has been examined by a physician who states that her breast exam is normal.

Watch breast cancer surgeon John West, MD, discuss the importance of regular breast self-exams.

Dr. Stuart A. Linder, MD
Plastic Surgeon

Breast self-exams are extremely important in women in order to act as a first line of defense in diagnosing a malignant tumor. Women should perform their self-breast examinations the day after their period ends and the same day should be done monthly. Self-breast examination requires palpation with 2 fingers of the entire breast mound, including the axillary region, in order to detect for lymph node involvement.

While there has been some data indicating that advocating monthly breast self-exams may lead to more invasive tests, knowing the "landscape" of your breast can help detect abnormalities. Having an idea what feels "normal" in your breast tissue may allow you to indicate when something does not feel quite right. If you have a concern, then make an appointment with your physician to talk it over and have a professional do an exam.

There is a difference of opinion within the medical community over whether breast self-exams should even be performed anymore. Traditionally it was taught that women should perform the exam around the same time of the month—for example, at the beginning or end of your period—and to be consistent, as the breast tissue can change through the menstrual cycle. More recently, the U.S. Preventive Services Task Force (USPSTF) recommended against teaching breast self-examination. However, the American Congress of Obstetricians and Gynecologists continues to state that women should be counseled on the potential for breast self-exams to detect palpable breast cancer, and that breast self-exams can be performed.

Dr. Jessica L. Keto, MD
Surgical Oncologist

A breast self-exam (BSE) is the first line of detection for breast cancer. In this video, Jessica Keto, MD, FACS, of Mercy Health, explains the importance of regular breast self-exams in helping you to identify small changes.

Trinity Health is a Catholic health care organization that acts in accordance with the Catholic tradition and does not condone or support all practices covered in this site. In case of emergency call 911. This site is educational and not a substitute for professional medical advice, always seek the advice of a qualified healthcare provider.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

A self-breast exam is crucial for breast cancer detection and prevention. In this video, Dr. Oz shows how to do a self-breast exam.

Dr. Anne M. Kobbermann, MD
Hematologist & Oncologist

Performing regular breast self-exams can help detect anything that is irregular or out of the ordinary, but how do we know what to look for? In this video, Anne Kobberman, MD, explains breast self-exams and how often you should do them.

Monthly breast self-exams (BSE) allow you to become familiar with what is normal for you. In this video, Jamie Caughran, MD, FACS, of Mercy Health, explains how noticing changes in breast tissue plays a role in diagnosing breast cancer.

Trinity Health is a Catholic health care organization that acts in accordance with the Catholic tradition and does not condone or support all practices covered in this site. In case of emergency call 911. This site is educational and not a substitute for professional medical advice, always seek the advice of a qualified healthcare provider.

Patricia Geraghty, NP
Women's Health

There are a number of professional organizations related to women's health. Members of these organizations review scientific literature to formulate evidence based guidelines on caring for women. None of the many guidelines currently recommend self breast exam. When the research was reviewed, the self breast exam was not shown as an accurate method to detect cancer, no breast cancer deaths had been prevented and self-exam had a high incidence of causing anxiety in women who felt normal breast changes. At the same time, those of us who have cared for women over the years can always remember a patient who found a lump that resulted in detecting a cancer. If you want to do self breast exams, ask your clinician to show you the best method.

To stay on top of your breast health, perform breast self-examinations.

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.
Leah Swenson
Oncologist

Our breasts change throughout your monthly cycle, and there is a specific window of time that is best for a breast self-exam. Women should examine their own breasts once a month, according to nurse practitioner Leah Swenson. In this video, she describes the best time to do the exam.

A breast self exam should be done the same time every other month. If you are still menstruating, the exam should be done 7 to 10 days from the first day you start menstruating. If you no longer menstruate, pick a date of the month and do your exam on that date every other month. While there is no evidenced based research that supports breast self examination in finding breast cancer early and saving lives, most breast specialist advocate breast self examination. Breast self examination promotes breast awareness and empowers women against the fight of breast disease. Breast self examination allows women to become familiar with how their breasts normally or usually feel. If your breast feels different then it usually does, such as a new lump, this should be brought to the attention of your primary care giver.

Tania Santos, RN
Nursing Specialist

Because your breasts change throughout your monthly menstrual cycle, you should establish a regular schedule to examine your breasts, and that time should be when your breasts are not tender or swollen. You can use the day your period ends as a reminder that your monthly self-breast examination is due. Most breast cancer organizations recommend that you should begin self-examinations to become aware of how your breasts normally look and feel in your 20s.

Dr. Sonia M. Ceballos, MD
OBGYN (Obstetrician & Gynecologist)

Breast self-awareness is more encouraged than a breast self-exam to know what normal for you looks like. Watch Sonia Ceballos, MD, of MountainView Hospital, explain self-awareness.

Mrs. La'Sheah M. Stewart, FNP
Nursing Specialist

You should be looking for lumps, drainage from nipples and any other abnormality. Performing a monthly breast exam will help you become more familiar with how your breasts look and feel so you can alert your healthcare professional if there are any changes.

Breast self-examination should be painless and can be a helpful tool for getting to know the way your breasts feel and look normally so that you can identify changes in your breasts more easily. Doctors recommended waiting until after the first few days of your menstrual period to do your breast self-examination, as breasts may feel more tender, swollen or lumpy in the days before your period arrives.

Begin the exam by lying down with your right hand behind your head, which allows the breast tissue to spread over the chest so it is as thin as possible and easiest to feel all the tissue.

  •  Using the finger pads of the three middle fingers of your left hand, use overlapping dime-size circular movements to feel the breast tissue.
  •  Alternate the pressure you apply from light to moderate to firm to be able to feel all the tissue from the skin surface down to the area closest to the chest wall and ribs.
  •  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. Check the entire breast area going down until you feel only ribs and up to the neck or collar bone.
  •  Repeat these steps to examine the left breast.

Next, stand up in front of a mirror. With your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape or contour, or dimpling, redness or scaliness of the nipple or breast skin. Slightly raise each arm to examine the underarm. Gently squeeze the nipple of each breast to check for discharge.

Although there is evidence that breast self-exam is not an effective screening tool, examining your breasts monthly allows you to get to know what's normal for your breasts and identify any changes more quickly. If you do notice any lumps, dimpling, unusual redness or inflammation or nipple discharge, call your doctor right away.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.