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
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
During the visual examination, you should be looking for:
- 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
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
When performing tactile examination, you might encounter:
||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
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
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.