Introduction to Self Breast Exam
Regular breast self-examination for women is often recommended by physicians as a means of checking for signs of breast cancer. Mammography is the most effective way of detecting breast cancer, but along with clinical breast examination by your doctor, a self breast exam is important in detecting any signs of abnormality and seeking medical attention. A home breast examination also makes a women more aware of her breasts, particularly the look and feel of the healthy breast, which will further aid in the early detection of any abnormality.
If you have decided to conduct regular self examination of your breasts, it is advisable to first speak to your doctor or gynecologist to learn how to do it properly and what to look for. For women older than 40 years of age, a self breast exam should not replace a clinical examination by a doctor and a mammography, both of which should conducted on a regular basis.
What is a Breast Self-Examination?
Breast self-examination is a method consisting of various steps for a woman to detect any changes in the appearance and structure of her breasts. It is intended to assist women in :
- becoming familiar with the normal appearance and feel of the breast,
- detecting any abnormality of the breast as early as possible,
- seeking medical attention for abnormalities.
When to do a Breast Self-Examination?
Every woman is encouraged to conduct a routine breast self-examinations from early adulthood starting in the twenties. This should be done on a monthly basis and should be followed by a clinical breast exam by a doctor or gynecologist at least once a year. Women with a family history of breast cancer or any of the risk factors associated with breast cancer should have a mammography annually, irrespective of age.
A self breast exam is best done about a week after the first day of the menstrual period when the breasts are least likely to be tender or swollen. Menopausal women should have a set date every month to conduct a breast self-examination since they do not have a menstrual cycle that will alert them of the exact day to conduct the exam. For breast feeding mothers it is best to do the examination after feeding the baby or after expressing the milk with the use of a breast pump.
Exam Procedure and Steps
There are two main steps involved in doing a breast self-examination – the visual exam and the physical exam. The breasts should also be assessed when standing upright and lying down flat during the physical exam.
The video below details all the points mentioned in this article with regards to the self breast exam.
Step 1 – Visual Inspection
In the first step, you should stand in front of a mirror with your arms hanging by your side.
- Observe the shape and size of your breasts. Both your breasts may not be symmetrical and it is quite normal for the breasts to be unequal in size and shape although this will not be extremely pronounced.
- Take note of the skin of the breast. Identify any puckering or dimpling of the skin. Also look for any discoloration or redness.
- Check for any nipple discharge. This discharge, if present, may vary between milky, mucinous (clear and watery), serous (yellowish), purulent (with pus) or bloody. Sores, peeling, crusting or other nipple abnormalities should be noted, as also any inversion of the nipples (nipple is ‘inside out’).
The breasts should be further observed in different positions.
- Place your arms on your hips and grasp the hips firmly. Take note of the shape, size, skin color and texture as well as any nipple discharge, nipples sores, peeling or crusting.
- Slowly turn to each side an watch for these signs again. You can also try bending forward to observe the breast in this position. Turning to each side allows you to observe the sides or outer quadrants of the breast.
- You may also examine the breasts by placing your clasped hands firmly behind your head. Extending the hands upwards and looking for the same signs is also useful.
These changes in position may seem tedious but they will allow you a complete visual examination of the breast in multiple orientations.
- The first symptom of breast cancer may be a painless lump in the breast detected on self-examination. Cancerous breast lumps are most often found in the upper, outer quadrant of the breast and in the area behind the nipple hence these regions should be examined with particular care.
- Puckering or dimpling of the skin or “peau d’orange” (skin of an orange) sign of the skin over the breast may be found in cases of breast cancer.
- Swollen armpit lymph nodes (axillary nodes) which are hard, fixed (immobile) or matted (stuck together) may be a sign of spread of breast cancer.
- The presenting symptoms of Paget’s disease of the nipple may be redness, crusting of the nipples, along with discharge from the nipples. A breast lump may be felt at a later stage.
Step 2 – Standing Exam
After completing the visual inspection, a physical examination will need to be done to feel for any changes in the breast tissue or to detect the presence of a lump. This part of the examination may be done in the shower (to facilitate smooth movements of the examining hand) or in a lying down position.
- In the shower, raise the left arm behind the head and with the flattened palm side of the fingers of the right hand examine the left breast by pressing down slowly.
- Move the fingers up gradually from below the breast line till the clavicle (collar bone) and repeat the movements till the whole breast has been covered.
- Change hands to examine the other breast.
- The nipples should be checked for any discharge by pressing gently.
- It is important to examine the axilla (armpits) for any lumps or thickenings. This is done by placing the left hand on the hips and examining the left armpit with the right hand. The maneuver is repeated on the other side to examine the opposite armpit.
- The area above and below the collar bone on either side are also examined for lumps.
Step 3 – Lying Position
The second part of the physical examination should be conducted while lying down.
- Place the left hand behind the head and with the flattened palm side of the fingers of the right hand examine the left breast.
- Starting at the 12 o’clock position on the upper part of the breast, move the fingers in small circles in a clockwise manner.
- On reaching the 12 o’clock position again, move the fingers inwards slightly towards the nipple and repeat the procedure and in this way cover the whole breast.
- Next, place the fingers flat on the nipples and examine for any abnormalities.
- Repeat this procedure on the other breast.
Types of Breast Exam Abnormalities
Any changes in the breast that are noted on conducting regular self-breast examination should be brought to the notice of the doctor. Of special importance are :
- Any change in size or shape of the breast.
- Any discoloration or redness of the skin over the breast.
- Change in appearance of the skin over the breast, such as dimpling or puckering.
- Pain and other signs of inflammation such as redness and warmth over a lump or the entire breast.
- Discharge of any sort from the nipples.
- Ulceration or crusting of the nipples.
- A lump in the breast, however small, should not be ignored whether it is painful or not.
- A lump in the axilla (armpit) or anywhere around the breast.
- An area of thickening in or around the breast, including the axilla (armpits).
Although breast self-examination is done with the intention of checking for signs that will help to detect early breast cancer, it should be remembered that most often the changes that are seen are not due to breast cancer but some other benign condition. Nevertheless, early detection and treatment of the condition will definitely give good results and increase survival rate in cases of breast cancer.
Article reviewed by Dr. Greg. Last updated on January 21, 2012