Breast Self-Exam and Awareness: What to Look for
We have all been there, during our physicals or well-woman checks and asked the same questions “Are you doing your monthly self-breast exams?” or “Any changes to breasts that you are concerned about today?”
Let’s be honest, some of us say, “Yes, every month I check and no everything is great!” While this may be true deep inside you are second-guessing if you have been doing them correctly.
Another group may say, “I try to check but I am not really sure what I am doing is correct or what I should be feeling for.”
Finally, we have the third group, who either are not familiar with self-breast exams or don’t really see the point, so they are not done at all.
Self-breast exams and awareness are important tools in the early detection of breast cancer. Women have a 1:8 lifetime risk of developing breast cancer while men have a 1:833 lifetime risk.
The earlier the cancer is detected, the easier it is to treat successfully, and the higher the survival rate.
Breast Self-Awareness or Breast Self-Exam: What’s the Difference?
In the last few years, you may have heard your healthcare provider say or performed a google search and found the phrase “breast self-awareness” when discussing or searching for breast self-exam, or maybe this is your first time reading about it.
Breast self-awareness is different and less formal than a breast self-exam.
It is meant to be used by women who are at average risk (meaning you do not have increased risk factors for breast cancer) and is based on new data found in studies and aims to reduce unnecessary and excessive testing and procedures.
- Breast Self-Awareness: A woman’s awareness of the normal feel and appearance of her breast. It does not recommend women examine their breasts in a routine or systematic way but to be aware of changes or potential problems in their breasts. Women should be educated on the signs and symptoms of breast cancer and when to notify their healthcare provider about a lump, pain, redness, or nipple discharge.
- Breast Self-Exam: A woman inspecting her breast on a routine, repetitive basis, in a systematic manner with the purpose of detecting breast cancer (self-screening). This practice is typically reserved for women at high risk of developing breast cancer along with other high-risk screening measures.
Is This Practice Reliable and How Often Should it be Done?
For women with an average risk of developing breast cancer, it is not recommended to perform monthly breast self-exams as it does not help reduce death from breast cancer.
This recommendation first came into place by the United States Preventative Task Force in 2009, and since then the American Cancer Society (ACS), National Comprehensive Cancer Network (NCCN), and American College of Obstetricians and Gynecologists have made the same recommendations.
So, what does this mean?
Since approximately 71% of breast cancers are self-detected by women under age 50 and 50% by women older than 50 this data provides a rationale to promote breast self-awareness as a method of detection endorsed by most top medical organizations.
Risk Factors for Breast Cancer
Factors that Cannot Be Changed
- Age-Most breast cancers occur in women older than 50
- Reproductive history- Early menstrual periods before 12 and late menopause after age 55 (women exposed to hormones longer)
- Having dense breast- makes it harder to see tumors on mammograms
- Genetic Mutations- inherited changes BRCA1 and BRCA2
- Personal history of breast cancer- likely to develop breast cancer a second time
- Family history of breast or ovarian cancer
- Previous Radiation Therapy to Chest- Particularly Hodgkin’s Lymphoma Patient’s who were treated under 30 years of age
- Women who took the drug diethylstilbestrol (DES), while pregnant as well as their children between 1940-1971
Factors that Can be Changed
- Obesity- especially after menopause
- Lack of exercise or physical activity
- Hormone Replacement Therapy (HRT)- taken during menopause particularly with estrogen and progesterone
- Reproductive History-First pregnancy after 30, no full-term pregnancies, not breastfeeding
- Drinking excessive alcohol
Signs and Symptoms of Breast Cancer
- Feeling a lump or mass
- Swelling of all or part of the breast even if no lump felt
- Breast or Nipple pain
- Nipple Discharge (other than breastmilk)
- Nipple Retraction (turning inward)
- Breast or Nipple skin that is red, dry, flaking, or thickened
- Skin Dimpling (can look like an orange peel)
- Swollen lymph nodes (sometimes cancer can spread to areas under the arm and along the collarbone causing swelling before lump or mass can be felt)
How to Perform a Breast Self-Exam
Breast Self-Exams are not required for average-risk women but are a good way to become familiar with your breast and how they look and feel. Below are three ways to perform a breast self-exam to help guide you in your own breast self-awareness.
In the Mirror
- Stand in the front of a mirror with your breasts exposed and your hands pressing firmly down on your hips
- Look in the mirror for the following changes in your breasts:
- Changes in size, shape, in contour
- Scaliness or redness of your breast or nipple skin
- Any discharge from your nipple
3. Raise one of your arms slightly and examine the area under that underarm. Feel the underarm for any lumps or changes. Repeat the same process with the other underarm. Please remember to not raise your arm straight up in the air as this tightens the tissue under the arms making it harder to examine.
- Lay on your back and place your right arm behind your head. When laying down, the breast tissue spreads out as thinly as possible, which can make it easier to feel all the tissue.
- Using the pads of your three middle fingers on your left hand to feel for lumps in your right breast. Move the fingers in dime-size circles up and down your breast. You will need to use three different levels of pressure on each spot you are feeling breast tissue before moving on to the next area. If you are unsure of the amount of pressure, please speak with your healthcare provider but the general rules are as follows:
- Light pressure: feels tissue closest to your skin
- Medium pressure: feels a little deeper
- Firm pressure: feels tissue closest to the chest and ribs. You may feel a firm ridge in the lower curve of each breast
3. Next, examine your entire breast using the vertical pattern (up and down pattern). You will start in your underarm and move your fingers little by little until you reach the bottom of your ribcage. Then slightly move your fingers towards the middle and repeat the process of moving little by little back up until you reach your collarbone. Repeat this pattern until you have covered your entire breast and reached your breastbone (sternum).
4. Repeat the exam on your left breast using your right hand and placing your left arm behind your head.
In the Shower
- Lather finger pads and breasts with soap. This will help the fingers glide smoothly over breasts making it easier to feel lumps in the breasts.
- Using the pads of your three middle fingers feel the entire breast in either circular dime-size or vertically up and down movements. Remember to use light, medium, and deep pressure in each spot before moving to the next.
- Start under your arm and don’t forget to go up towards your collarbone, and move toward your breastbone and lower ribcage little by little. To examine your right breast place your left arm behind the head in a relaxed position and to examine your left breast, place the right arm behind the head in a relaxed position to examine your left breast.
How K Health Can Help
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Frequently Asked Questions
K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
Breast cancer risk assessment and screening in average-risk women. ACOG. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/07/breast-cancer-risk-assessment-and-screening-in-average-risk-women
Breast cancer screening (PDQ®)–patient version. National Cancer Institute. https://www.cancer.gov/types/breast/patient/breast-screening-pdq
Breast Self Awareness. Susan G. Komen®. https://www.komen.org/breast-cancer/screening/self-awareness/
Breast self-awareness and breast self-exams (BSE). Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/patient-education/breast-self-awareness-breast-self-exam
What is breast cancer screening? Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/breast/basic_info/screening.htm
Detecting breast cancer early. American Cancer Society. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html