Breast Self Exam
How exactly should I do the breast self-exam?
There are several techniques, including one in which you go round and round the breasts in a circular motion, (see Fig. 1) and another in which you do a series of up-and-down strip searches of the breast and pie-shaped wedges (see Fig. 2). The up-and-down (vertical) strip search method, (see Fig. 3) as it tends to cover all of the breast tissue. With the circular method, it's easier to miss a ring of breast tissue as you're going round and round.
There are two key concepts involved in the proper use of this method of breast self-exam. The first one involves using three different levels of pressure when feeling the breasts (see Fig. 5). The idea is to check the breast at various depths, rather than doing one simple check in which you try to push all the way down inside the breast.
Can you describe how I should use my fingers to examine my breasts?
Using the pads of your fingers, (see Fig 5) first apply light pressure to the breast, as you are checking the area just slightly underneath the breast skin's surface. Next, apply medium pressure to the breast, checking about midway inside the breast. And finally, apply deep pressure, feeling for the area deepest in the breast. You should use these three pressures as you examine your breasts.
The second critical concept in doing the breast self-exam is to cover all of your breast tissue. But remember that tissue can cover a lot more ground than most women realize. Breast tissue often extends up to the collarbone; down to the rib cage or even below the rib cage and bra line; and all the way to each underarm. Your self-exam should cover this landscape as well. And most importantly, do not allow your fingers to stop or lift away from your breast at any point in the middle of the exam. Here's what to do:
Lie on your side, but twist back a bit so your breast falls as flat as possible on your chest, rather than hanging down toward the floor (see Fig. 6). This helps you to cover more surface area and allows you to apply firm pressure against a hard surface. Now you can begin your "strip search" of the breast. Do your light, medium, and deep presses in straight lines moving in vertical lines from your collarbone down below your bra line and covering the area from the armpit to the breastbone. Use the left arm to check the right breast and vice versa. You might want to use lotion or powder to help you move over the breast smoothly. Do not squeeze the nipples. If you notice a discharge, bring this to the attention of your doctor.
Examine breasts one at a time, and examine both breasts every time. And do the exam every month. With time, you will become intimately familiar with the architecture of your breasts, and well equipped to tell your doctor about any new changes in them. If you feel a new potential "abnormality," check the other breast in the same region to see if it's symmetrical.
Is there a better or worst time to do the breast self-exam each month?
It's useful to do the breast self-exam at the same time each month, because the breasts tend to change (as a result of changing hormones) throughout a woman's monthly cycle. If you have a regular menstrual cycle, then the best time to do the breast self-exam is about seven to ten days after your period begins each month. At this time, your breasts are the least lumpy and the least tender to the touch.
If you don't have regular monthly periods, then try to do your breast self-exam on the same day each month--for example, on the first of every month, the day you pay your monthly bills, your bridge game, or something else you won't forget.
Can you give me some general guidelines on what to "feel" for in my breasts?
Most women's breasts have lots of bumpy or nodular areas in them. Only young girls' breasts are perfectly smooth. The goal in checking your breasts is to find dominant lumps--something that stands out and that is not symmetrical with the other breast. Symmetry is very important: if you find the same lump on the other breast, it's usually normal.
Search for lumps that are hard, irregular in shape, not painful, and not mobile (i.e., something that's attached to the skin or muscle and that doesn't move). These can be (but aren't always) problem signs, and should be brought to your doctor's attention. The lump can be in the breast area, under the arm, or anywhere else in the region. Also, if such a lump is associated with a change on the skin of your breast, tell your doctor.
On the contrary, lumps that are mobile, smooth, painful, and unattached are generally nothing to worry about, but always need investigation. Certainly painful lumps can be cancerous. Always tell your doctor of a new lump.
Finally, remember that breast tumors appear in areas other than the breast itself. Breast tissue can extend all the way over to the underarm; up to the collarbone; and down to the rib cage.
The bottom line is, you can't be perfect. But do the best you can--and bring anything suspicious to your doctor's attention.