Breast Self-Exams in Breast Cancer

Taking charge of your breast health is a proactive step every individual can embrace. While advancements in medical technology provide invaluable tools for screening, a fundamental and accessible practice remains a cornerstone of personal health vigilance: the breast self-exam (BSE). This simple yet profound routine fosters breast awareness, empowering you with an intimate understanding of your body, which can be pivotal in the early detection of breast cancer. Understanding your breasts is not just about identifying problems; it’s about knowing what is normal for you, so you can recognize when something changes and seek timely medical advice. 

Many instances of breast cancer are first detected by individuals themselves. This highlights why integrating breast self-exams into your routine is a meaningful way to contribute to your overall breast cancer prevention strategy, even if it’s not a sole diagnostic tool.

What is a Breast Self-Exam?

A breast self-exam (BSE) is a method of self-assessment that combines both physical and visual inspection of your breasts to check for any signs or symptoms that might indicate breast cancer. It’s a structured approach you can take at home to become accustomed to the typical look and feel of your breasts. The primary purpose of a breast self-exam is to establish this baseline familiarity with your breasts. By understanding what is normal for you, you are better equipped to identify any new or unusual changes or abnormalities, such as a new lump, thickening, or skin alteration, if they were to occur. This ongoing practice helps you maintain vigilance over your breast health.

While medical experts acknowledge that BSEs have not been shown to reduce deaths from breast cancer as a standalone screening method, they emphasize the undeniable value in being familiar with your own breasts. Knowing what’s typical for your body enables you to report any changes to your healthcare provider promptly, potentially leading to the detection of breast cancer when it is small and may require less intensive treatment.

Step-by-Step Guide: How to Perform a BSE Correctly

Performing a thorough breast self-exam involves a combination of visual inspection and manual palpation. It’s a process that only takes a few minutes but provides crucial information about your breast health. Adult women of all ages are encouraged to perform these exams at least once a month. The timing is important: if you still menstruate, the best time to perform a BSE is a few days after your period ends, as your breasts are less tender and lumpy at this time. For those who are post-menopausal, choose a consistent day each month, such as the 1st or 15th, to conduct your exam. Remember that breast tissue extends beyond what you might traditionally consider your breast, reaching into your armpit, up to your collarbone, and down to the top of your abdomen, so it’s important to include these areas in your examination.

The National Breast Cancer Foundation outlines three essential steps for a complete breast self-exam. Cleveland Clinic also presents a helpful framework known as the “Seven P’s” to guide your examination.

1) In Front of a Mirror (Visual Examination)

Begin your breast self-exam by standing or sitting shirtless and braless in front of a mirror with your arms at your sides.

• Position 1: Arms at Your Sides
  • Observe your breasts for any changes in their contour, shape, or size.
  • Look for any dimpling, swelling, puckering, or other skin irregularities on or around your breasts.
  • Check for any changes in your nipples, such as them turning inward.
• Position 2: Hands on Hips, Flexing Chest Muscles
  • Place your palms firmly on your hips and press down to flex your chest muscles.
  • Again, look for any dimpling, puckering, or other changes, paying close attention if these changes appear particularly on one side. It’s important to note that perfect symmetry between your left and right breasts is uncommon.
• Position 3: Arms Raised Overhead
  • Raise your arms high above your head and visually inspect your breasts for the same changes as before.
• Position 4: Lifting Breasts
  • Lift each breast to check if the ridges along the bottom are symmetrical.

If you have a vision impairment, consider asking a trusted friend or family member for assistance with the visual inspection.

2) In the Shower (Physical Examination – Standing)

Many find the shower to be an ideal setting for the physical part of the breast self-exam, as the soap and water help your fingers glide more smoothly over your skin.

• Pads of Your Fingers: Use the pads (not the very tips) of your three middle fingers. If these don’t feel sensitive enough, try using your palm or the backs of your fingers.
• Pressure Levels: Apply light, medium, and firm pressure to feel different depths of the breast tissue. Start with light pressure for the tissue closest to the skin, then medium pressure to feel a little deeper, and finally firm pressure to feel the tissue closest to your chest wall and ribs. Ensure you use each pressure level before moving to the next spot.
• Pattern: To ensure you cover the entire breast area, including up to your armpit, use a systematic pattern. Some prefer a circular motion, while others imagine their breast divided into wedges, like a pie, moving their fingers from the outer edge towards the nipple in each section.
• Check Armpit and Nipple: Don’t forget to press the tissue nearest your armpit and around your areola. Gently squeeze your nipple to check for any discharge.
• Repeat: Repeat these steps for both breasts each month.

3) Lying Down (Physical Examination)

Performing a breast self-exam while lying down can be particularly effective, as the breast tissue spreads out evenly along the chest wall, making it thinner and potentially easier to feel changes, especially for individuals with larger breasts.

• Preparation: Lie on your back on a bed or flat surface. Place a pillow under your right shoulder and put your right arm behind your head.
• Examination: Using the pads of your three middle fingers on your left hand, thoroughly check all parts of your right breast, including the armpit area. Use light, medium, and firm pressure, just as you did in the shower, to feel for any new lumps, thickenings, hardened knots, or other breast changes.
• Nipple Check: Gently squeeze the nipple to check for discharge.
• Switch Sides: Repeat these steps for your left breast, placing the pillow under your left shoulder and using your right hand.

The “Seven P’s” of breast self-examination can also serve as a helpful checklist:

1. Position: Inspect your breasts both in the mirror and lying down.
2. Perimeter: Include the area of your breast that extends to your armpit.
3. Palpation: Move your three middle fingers in a gentle, circular motion.
4. Pressure: Use light, medium, and firm pressure.
5. Pattern: Use a systematic pattern to ensure you cover your entire breast.
6. Practice: Perform self-exams regularly to build familiarity.
7. Planning: Understand what you’re looking for and what steps to take if something seems unusual.

Benefits of Breast Self-Exams

The practice of regular breast self-exams offers several significant advantages in promoting breast health and contributing to the early detection of breast cancer.

Firstly, BSEs are an unparalleled tool for fostering familiarity with your own breast tissue. Over time, consistently performing self-exams allows you to learn the typical look and feel of your breasts, including their natural lumps, textures, and contours, which can change due to hormonal fluctuations or age. This personal baseline knowledge is incredibly powerful, as it enables you to confidently recognize when something is different or unusual. As Lillie D. Shockney, Johns Hopkins University Distinguished Service Professor of Breast Cancer, emphasizes, “Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important”. This statistic underscores the profound impact an individual’s awareness can have.

Secondly, this heightened breast awareness is directly linked to the early detection of changes. When you know what is normal for your breasts, you are much more likely to notice even subtle alterations, such as a new lump, a thickening, an inverted nipple, or skin changes like dimpling or redness. Many individuals with breast cancer have reported that finding a lump at home was their first indication that something was amiss. Discovering a breast change and reporting it promptly to your healthcare professional can lead to the diagnosis of breast cancer when it is still small. Small breast cancers, detected early, often require less intensive treatment, potentially improving outcomes. Therefore, while BSEs are not a standalone diagnostic method, they play a crucial role in empowering individuals to be proactive and informed advocates for their own breast health.

Limitations of Breast Self-Exams

While breast self-exams are a valuable component of breast awareness, it is absolutely critical to understand their limitations. BSEs are not, and should never be considered, a replacement for routine clinical breast exams performed by a healthcare provider, nor for recommended screening tests such as mammograms.

Healthcare providers acknowledge that while knowing your breasts is important, there are more effective ways to detect and screen for breast cancer. Research has not conclusively shown that routine breast self-exams are effective in reducing deaths from breast cancer when used as a primary screening tool. This is largely because mammography, a sophisticated imaging technique, can often detect tumors before they are large enough to be felt during a physical examination. Therefore, combining breast self-exams with regular medical care and guideline-recommended mammography is the most comprehensive approach to early detection of breast cancer.

There are also potential risks and issues associated with relying solely on BSEs:

• False Sense of Security or Overestimation of Benefits: Some individuals may mistakenly believe that because they perform regular breast self-exams, they do not need to undergo professional clinical breast exams or mammograms. This is a dangerous misconception, as BSEs supplement, rather than replace, professional screenings.
• Anxiety from Finding Lumps: It’s common to find lumps or other changes in breast tissue that are not cancerous. The discovery of a suspicious lump during a self-exam can lead to significant worry and anxiety until a proper medical evaluation can be performed. It’s reassuring to remember that approximately 8 out of 10 lumps found are benign.
• Need for Further Tests: If you do find a suspicious lump or change, it will likely necessitate further diagnostic tests and procedures. This might include a diagnostic mammogram, an ultrasound, or even a biopsy to remove tissue for laboratory testing. If the lump turns out to be non-cancerous, you might feel that you’ve undergone invasive procedures unnecessarily.
• Difficulty with Certain Breast Types: Breast self-exams can be particularly challenging for individuals with fibrocystic breasts, a common condition where breast tissue feels naturally lumpy. This can make it harder to distinguish between normal tissue and new, potentially concerning changes.

Despite these limitations, healthcare professionals still advocate for breast awareness through self-exams, as it encourages individuals to report changes promptly, facilitating further investigation by medical experts.

Encouraging Breast Awareness: When to Seek Medical Advice

The true power of breast awareness cultivated through breast self-exams lies in knowing when to seek professional medical advice. The goal is not to self-diagnose, but to identify changes early and promptly discuss them with a healthcare provider.

It’s crucial to contact a healthcare provider immediately if you notice any of the following changes in your breasts:

• A New Lump or Change in Feel: This could be a hard lump or knot in your breast tissue or near your underarm. This also includes any thickening or noticeable fullness that feels different from the surrounding tissue. Remember, your breasts naturally have lumps, but it’s the new or different ones that warrant attention.
• Unusual Nipple Discharge: This includes any discharge from your nipple, especially if it is bloody.
• Skin Changes: Look for dimpling, puckering, bulges, or ridges on the skin of your breast. Other skin changes that require attention include redness, soreness, a rash, swelling, or skin that appears like an orange peel. Itching, scales, or sores on the breast skin are also warning signs.
• Nipple Changes: A recent change where a nipple becomes pushed inward (inverted) instead of sticking out, or changes in the overall direction of the nipple, should be reported.
• Changes in Size or Shape: While some asymmetry is normal, any new, noticeable changes in the size or shape of one breast compared to the other should be evaluated.
• Changes in Warmth or Pain: Persistent changes in the warmth or pain level of your breast could also be a sign.

Even if you have recently had a mammogram or have one scheduled soon, it’s important to report any new findings from your breast self-exam to your healthcare professional. Mammograms, while highly effective, can sometimes miss small cancers or those located in difficult-to-see areas.

Upon reporting a concern, your healthcare provider will likely perform a clinical breast exam and may recommend further diagnostic imaging tests, such as an ultrasound or a diagnostic mammogram, to investigate the change. In some cases, a breast biopsy, which involves removing breast tissue for laboratory analysis, may be necessary. It is crucial to follow through with these recommendations to get an accurate diagnosis and ensure proper early detection of breast cancer.

Conclusion : Empowering Individuals with Knowledge and Awareness

The journey of maintaining optimal breast health is a lifelong commitment, and the breast self-exam (BSE) serves as an accessible and empowering tool within this journey. While not a substitute for professional screenings like mammograms or clinical breast exams, regular BSEs are an integral part of fostering breast awareness, enabling individuals to become intimately familiar with their own bodies.

By routinely performing breast self-exams, you gain a vital understanding of what is normal for your breasts. This invaluable personal knowledge empowers you to detect subtle changes that might otherwise go unnoticed, playing a crucial role in the Early detection of breast cancer. Catching breast cancer early can significantly impact treatment options and outcomes.

The goal is not to create undue anxiety but to encourage vigilance and proactive engagement in your Breast Health. If you discover any unusual changes, remember that most lumps are not cancerous, but Dr.Sekhar Breast Cancer Treatment specialist in hyderabad Consultation is always the wisest course of action. By combining the consistent practice of breast self-exams with regular clinical evaluations and mammography, you are taking comprehensive steps towards safeguarding your health and actively participating in breast cancer prevention through informed breast awareness. Empower yourself with this knowledge and integrate regular self-exams into your routine – it’s a simple yet profound way to prioritize your well-being.