How to perform a breast self-exam
A breast self-exam involves both visual and physical examination of your breasts.
Visual examination
Disrobe and stand in front of a mirror with your arms at your sides. Visually inspect your breasts while facing forward and while turning from side to side. You're looking for any signs of puckering, dimpling or changes in size, shape or symmetry. Check to see if your nipples are turned in (inverted). Look for these same signs with your arms in two other positions: hands on your hips and hands raised overhead, palms pressed together.
Physical examination
Examine your breasts either in the shower or while lying down with no shirt or bra on.
If you choose to perform the exam in the shower, lather your fingers and breasts with soap to help your fingers glide more smoothly over your wet skin. If you choose to examine your breasts while lying down, choose a bed or other flat surface to lie on.
You can use one of two patterns to examine your breasts:
Clock pattern
Place your left hand behind your head and examine your left breast with your right hand. Think of your breast as the face of a clock. Place your right hand at 12 o'clock — at the very top of your breast. Using the pads of your three middle fingers, press firmly in a slight circling, massaging motion. Feel for lumps as you move your hand down to 1 o'clock then 2 o'clock, continuing until you return to 12 o'clock. Slide your fingers closer to the nipple and repeat the circling motion around the imaginary clock face. Continue in increasingly smaller circles until you reach the nipple. Check the tissue under the nipple and look for discharge. Also check the tissue under your armpit, as well as tissue surrounding the breast, using the same firm, circling motion.
Place your right hand behind your head and repeat the examination on your right breast using your left hand.
Wedge pattern
Place your left hand behind your head and examine your left breast with your right hand. Imagine your breast to be a circle divided into wedges, like pieces of a pie. Starting at the top of the circle about a half-inch below your collarbone, use the pads of your three middle fingers to examine your breast. Press firmly in a slight circling, massaging motion as you slide your fingers inward toward your nipple. Once you've examined the breast tissue in that wedge, move in a clockwise direction to the next wedge in the circle. Continue examining your breast in this manner until you've completely examined your breast and underarm.
Place your right hand behind your head and repeat the examination on your right breast using your left hand.
Pros and cons of breast self-exams
Breast self-exams alone don't reduce the number of deaths from breast cancer. However, if you combine breast self-exams with clinical breast exams and mammography, you can reduce your risk of dying of breast cancer.
One benefit of breast self-exams lies in the potential to identify and treat a cancerous breast lump while it's still small and in an early stage of development. Early detection of breast cancer leads to the best chances of beating the disease. On the flip side, however, is that you might need a biopsy to evaluate the area of concern. If the biopsy results are noncancerous (benign), you might feel that the biopsy was unnecessary — but at least you'll know that you don't have cancer.
Know that breast self-exams can miss tumors, as can other methods of screening. That's why it's important to rely on more than one method to screen for breast cancer. Regular clinical breast exams and yearly mammograms in conjunction with breast self-exams — not only increase your breast familiarity, but may just save your life.
The Five Steps of a Breast Self Exam
Breast Self Exam Step 1:
Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.
Here's what you should look for:
- breasts that are their usual size, shape, and color.
- breasts that are evenly shaped without visible distortion or swelling.
If you see any of the following changes, bring them to your doctor's attention:
- dimpling, puckering, or bulging of the skin.
- a nipple that has changed position or an inverted nipple
- redness, soreness, rash, or swelling.
Breast Self Exam Step 2:
Now, raise your arms and look for the same changes.
Breast Self Exam Step 3:
While you're at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge (this could be a milky or yellow fluid or blood).
Breast Self Exam Step 4:
Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few fingers of your hand, keeping the fingers flat and together.
Cover the entire breast from top to bottom, side to side—from your collarbone to the top of your abdomen, and from your armpit to your cleavage.
Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. Be sure to feel all the breast tissue: just beneath your skin with a soft touch and down deeper with a firmer touch. Begin examining each area with a very soft touch, and then increase pressure so that you can feel the deeper tissue, down to your ribcage.
Breast Self Exam Step 5:
Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in Step 4.
Breast physical exam
Some women wonder why they need to have their doctors examine their breasts when they're doing regular self-exams on their own. While it's true that most lumps are found by women themselves, a breast exam by a doctor helps find lumps that women may miss. Sometimes, the abnormality in a breast can be so difficult to feel that only someone with experience would recognize it. Lumps, thickening, asymmetry changes in your breasts that you may not notice or think are normal, may be picked up on by people who examine many breasts regularly.
Studies show that regular breast self-exams, combined with an annual exam by a doctor, improves the chances of detecting cancer early.