What is a breast self-exam?

A breast self-exam is a step-by-step procedure a woman can use to examine her own breasts for any changes in breast consistency.

Examining your own breast periodically for any telltale signs of growth can help detect a lump in the breast at an early stage. Moreover, if it turns out to be malignant, the chances of a cure will be higher when detected in the early stages of breast cancer.

Once you’ve told your doctor about the lump that you felt, he will then run you through some diagnostic tests to rule out or confirm breast cancer. The diagnosis results will give him a complete picture of the type of your breast cancer, the stage, and the grade of the cancer. He then chooses the best treatment option for you.

Purpose of breast self-exam

The purpose of breast self-examination is to detect a breast cancer lump early. Early detection before the spread of cancer leads to prompt treatment, which increases the survival rate, chances of cure, and normal life span of the breast cancer patient.

Most lumps are not cancerous, but you should still report any abnormality to your doctor.

Doing a self-breast exam (BSE) every month will make you used to the general normal feel of the breasts. Therefore, should a lump develop, you will be able to detect it promptly. Breast exam forms part of breast screening for breast cancer.

Although the breast self-examination is not always reliable and you may miss feeling a lump, many women report that they first discovered a new breast lump on their own.

More than 90% of breast cancers are discovered by women themselves before being discovered at the clinical examination by a doctor. This applies to women in developed countries where breast cancer awareness is more widespread.

It is, therefore, recommended that you become familiar with the normal feel of your breasts.

Breast self-exam procedure: Important steps

You carry out a self-examination of your breasts to feel for any lump or lumps in the breast.

It is recommended that you ask your doctor for a demonstration. Before you begin breast self-exams, you may find it helpful to discuss the proper technique with your doctor.

1. Visual examination

You should stand in front of the mirror with the upper part of the body exposed for proper visualization of the breasts. Visual examination of both breasts from the front helps to detect any differences in the size and shape of the two breasts.

Do not be alarmed if the breasts are different in shape and size. Most women’s breasts do differ. You should look for any changes in the skin over the breast, puckering, dimpling, and any redness and swelling.

Inspect the nipples and look for any sores or skin changes or changes in the direction of the nipples such as an inverted nipple.

2. Manual inspection using your hands

You should examine both breasts by hand to feel for any variation. Use the pads of your fingers and not the tips of the fingers.

You should perform the exam in varying positions by placing the same-sided hand above the head (eg. right hand for right breast) and again by the side and again in a lying down position.

  • Standing up position. Place the flat of the hand over the breast and palpate the breast to feel for any abnormality. Look for any lump or soreness with the pads of the three middle fingers. Use the right hand to examine the left breast and the left hand to examine the right breast. Doing this in the shower by applying soap to the fingers will facilitate an easier movement of the hand over the breast. Apply enough pressure so that you can feel through the breast tissue. Move your fingers from the outer area towards the nipple in each quadrant of the breast. Cover the entire breast.
  • Lying down position. Place the right hand behind your head and move the pads of the fingers of the left hand over the right breast. Move the fingers in a circular motion and cover the entire breast in a clockwise direction. Apply enough pressure to feel through the breast tissue without causing any discomfort.

3. Look for enlarged lymph glands

Look for the presence of any swelling in the axilla (armpit) and above the collarbone. A swollen lymph gland in these areas may indicate that the cancer cells may have spread to these areas.

4. Nipple exam

Gently squeeze the nipples to rule out any discharge. A clear or blood-stained discharge may indicate breast cancer.

5. Feeling for consistency

Lumps that are smooth soft and movable are likely to be benign while lumps that are hard and fixed or attached are likely to be malignant. A breast exam can help in detecting a lump in the breast in the early stages and point to further investigations.

Best time to conduct breast self-exam

Every woman should conduct a breast self-exam once every month beginning at age 20 and should continue it each month throughout her lifetime.

You should choose a time in your menstrual cycle when your breasts are least tender. The best time to do a self-exam breast exam for breast awareness is usually the week after your period ends.

This is because that is the time when your breasts are least likely to be swollen and tender. Women who have stopped menstruating can pick a particular day each month like the first day of the month.

Limitations of breast self-exam

However, some of the medical fraternity does not believe that a self-exam of the breast is of much help. This is because it has not improved any survival rates. In suspected cases, it has subjected the woman to unnecessary biopsies and surgeries.

A breast cancer tumor does not have a steady growth, in which case the breast exam could have proved productive.

You may detect nothing on a self-breast exam in a particular month, while in the next month, you could feel a growth the size of a walnut.

But still, theories abound and some do feel the need to educate a woman on aspects of self-examination of the breast. This becomes especially true in case you are a high-risk woman of developing breast cancer.

Disadvantages of breast self-exam

Having felt a lump, you do become tense and anxious. This anxiety can last for a long time until the confirmation of the test arrives.

In addition, 80% of the breast lumps where biopsies have been done have proved to be benign (non-malignant). This makes the point that the woman unnecessarily goes through mental torture till the benign report comes.

The woman also has to go through various tests to confirm breast cancer. Invasive procedures such as a biopsy are performed, which are negative in about 80% of the cases. Studies have concluded that breast self-exam does not save lives as explained above.

The American Cancer Society and the American Preventive Services Taskforce, therefore recommend that it not be performed because of lack of benefits and existing disadvantages.

Breast cancer quadrant wise

Cancer tumors occur more in certain parts of the breast than in others. The following data should be kept in mind while carrying out your breast self-exam.

  • 50% of breast growths in the upper outer quadrant turn out to be cancerous
  • 15% in the upper inner quadrant
  • 6% in the lower inner quadrant
  • 11% in the outer lower quadrant
  • 18% around the nipple

To summarize:

On finding any of the abnormalities mentioned below while carrying out your breast self-examination, do not hesitate to consult your doctor. And don’t worry as more than 80% of lumps in breasts have turned out to be non-malignant.

Look for

  • Any change in the shape and size of the breast
  • Any change in the appearance of the skin over the breast
  • Any change in the appearance of the nipple
  • A lump in the breast
  • Swelling in the axilla
  • Swelling above or below the collar bone