Breast health

Breast self-examination

Learning the topography—that is, the texture—of your breasts is vitally important in the early detection of breast cancer. Statistics tell us there is a greater than 1 in 10 chance that a woman will develop breast cancer in her lifetime and that over one million women will find lumps in their breasts—reason enough to perform breast self-examination (BSE). BSE could be the key to the early detection of breast cancer. Women over the age of 20 should perform BSE on a monthly basis and it is never too late to learn to perform breast self-examination.

Breast self-examination is intended to help you become familiar with the texture of your breasts. Knowing how your breasts normally feel will better enable you to notice any changes or abnormalities in the future. The detection of breast cancer typically consists of BSE, mammography and clinical breast examination. Whether breast self-examination can reduce the number of deaths to breast cancer has been the subject of debate, which is why you should never rely on BSE as a substitute for mammography and clinical breast examination. Although BSE is simple to perform, it is also the least reliable method for detecting breast disease. Because of this, BSE should be used in combination with mammography and clinical breast examination.

Clinical breast examination by a health care professional should be performed at least every three years after age 20 and every year after age 40. Mammography should be done every year starting at age 40. If you are under 40 with either a family history of breast cancer or other concerns about your personal risk, your doctor will be able to tell you when to start getting mammograms and how often to have them.

How to perform BSE

Breast self-examination takes only a few minutes, and it could well be the best time investment of your lifetime. Learn how to perform BSE and commit to doing BSE regularly.

Breast self-examination should be performed monthly and at the same time each month. If you are still menstruating, it's recommended that BSE be performed the week (2 to 5 days) after the end of your period. It's during this time that your breasts will be the least tender. If your periods are irregular, or if you are pregnant or post-menopausal, try to perform BSE on the same date each month. If you are breastfeeding, BSE should be done after the breasts are emptied.

Performing breast self-examination is done in two steps. First, look at your breasts. Then, feel them.

Looking: visual examination

During the visual examination, you are looking for changes in each breast. Use a mirror wide enough to see your entire chest, and check the shape and size of your breasts. Note the color and texture of your skin, first with your arms down at your sides, then with your arms raised above your head. Be sure to look at yourself from both a frontal and a profile view.

The next step is to push down on your hips while turning your shoulders in. This tightens the chest muscles. Examine your breasts while standing with your hands on your hips. Then, bend forward at the waist with your hands on your hips. Doing this will help you spot dimpling or tugging at the skin or nipple caused by a growing tumor.

During the visual examination, you should be looking for:

• shape
• size
• contour or symmetry
  Is there a difference in the level between your nipples? Do both breasts look symmetrical?
• skin discoloration or dimpling
• bumps or lumps
  Normal lumpiness, particularly during the week before your period is expected to start, will appear as very small and separate lumps—much like the texture of an orange.
• sores or scaly skin
• discharge or puckering of the nipple

Touching: tactile examination

Regardless of the size of your breast, tactile examination is the same. The only exception is that large-breasted women should ensure they are seeing and feeling the entire breast and surrounding area. They should lie on their side to check the outer half of the breast. Keeping the hand on the nipple to mark the midline, they can then roll onto their backs to examine the inner half of the breast.

By the same token, small or thin women should be sure they can tell whether any hard lump they may feel is a rib bone or an actual breast lump.

Tactile examination is performed most effectively while lying down. Begin by placing a folded towel or pillow under the shoulder and extend your arm out at an angle. Doing this helps spread the breast tissue more evenly.

To perform this part of BSE, you should pick a pattern to use to feel your breasts and surrounding areas. Be sure to feel the entire breast, the underarm, the area between the breast and the underarm, and finally, the area above the breast up to the collarbone and across to the shoulder. Why all these different areas? It's important to check these areas because breast cancer may be found in the lymph nodes around the breast—in the axillary nodes under the arm, in internal mammary nodes in the chest, in supraclavicular nodes above the collarbone, and in infraclavicular nodes below the collarbone.

Using the pads of three fingers, check from the armpit to the breastbone and from the collarbone to the bra line. It makes more sense to use the pads of your fingers—they are more sensitive than the fingertips. With the pads of your fingers, make three dime-sized circles. First, lightly, moving the skin without moving the tisue underneath. Then, deeper, midway into the tissue. Then the last one deeper still, down to the ribs. This will allow you to check the full thickness of your breast. Move your fingers down and make the circles again: light, medium, deep.

Remember: when moving your hand, don't lift the fingers from the skin. Keeping your fingers on your breast will keep you from missing a spot. Move your hand spot by spot, going up and down in vertical strips as wide as your three fingers. Use this zigzag pattern to move from the armpit to the breastbone. Remember to go as high as the collarbone and as low as the bra line. Once you have finished, lower your arm and examine your armpit. Do the same with the other breast.

You are checking for any firm lump or thickening that feels different from the rest of your breast tissue. If you've never performed BSE before, you may need to do it a month or two before fully understanding what changes look and feel like. You should also keep in mind that most lumps are not cancerous. Nevertheless, be sure to check with your doctor if you find any breast changes or abnormalities.

When performing tactile examination, you might encounter:

Benign Changes

Possible Signs of Breast Cancer

Tender, lumpy breasts are typically caused by swelling and water retention as part of your menstrual cycle. Overall small lumps and a bumpy, grainy texture found in both breasts and confined to the area around the nipple and to the upper and outer parts of the breast are usually indicative of fibrocystic breast disease, a benign condition. A single lump that feels like an oval, is hard on the outside and squishy on the inside may be cyst. Cysts under the skin can usually be moved with the fingers, producing dull pain. Cysts—fluid-filled sacs—are benign and appear most often in women 35 to 50. Cysts increase as menopause approaches. A single, solid lump that feels like a rubber ball and that can be moved is usually a fibrodenoma, a benign and painless tumor made up of connective tissue and other cells. Fibrodenomas are more common in women in their late teens and early 20s and in older women on hormone therapy. Overall distinct large lumps may be pseudolumps or exaggerated lumpiness caused by scar tissue, fat cells or an abscess.

A single, solid lump that cannot be moved may indicate breast cancer. Look for hard, irregular borders and determine whether the lump appears in only one breast. Note whether the lump remains the same size throughout your menstrual cycle. Thickened or dimpled skin is a sign of a lump that cannot be moved. If you notice such a lump, see your doctor immediately: these are signs of breast cancer. Open, itchy sores or scaly skin could simply be a sign of a skin infection. However, this could also be a sign of Paget's disease, a rare form of breast cancer. Persistent clear or bloody discharge may indicate cancer in the breast ducts. An inverted or puckered nipple may also be a sign of breast cancer.

If you're unsure whether what you are feeling is normal, visit your doctor to get his or her opinion.

If you've had breast implants, you can still perform BSE by following the steps outlined above: looking and feeling.

Remember: to be effective, your early detection plan must combine breast self-examination with regular mammograms and clinical breast examination.