Breast self-examination, commonly referred to as BSE, is an important component of early detection of breast cancer and should be introduced to women beginning in their 20s. Women should do breast self-exams on a monthly basis at approximately the same time of the month; 2 to 3 days after the menstrual cycle. Breasts are usually the least lumpy and tender during this time.
The breast changes in shape, size and texture during the course of a woman’s life, reproductive cycle and within the monthly hormone cycle. The normal quality of most breasts is “lumpy and bumpy” and most benign lumps come and go during the month. It is the lumps that persist that need evaluation first by mammography and ultrasound. Because women say they don’t know what to look for when doing a self-examination, they can develop familiarity with their breasts with regular examinations so that it becomes easier to notice changes. Finding a breast change does not mean that a cancer is present.
The following guidelines for Breast Self-Exams, suggested by the American Cancer Society, provide a step-by-step systematic approach for the exam.
+ The best time for a woman to examine her breasts is when the breasts are not tender or swollen.
+ Women who are pregnant, breast-feeding, or have breast implants can also choose to examine their breasts regularly.
+ Women who examine their breasts should have their technique reviewed during their periodic health examinations by their health care professional.
+ It is acceptable for women to choose not to do BSE or to do BSE occasionally. If you choose not to do BSE, you should still be aware of your breasts and report any changes without delay to your doctor.
1. Lie down and place your right arm behind your head.
The exam is done while lying down, and not standing up, because when lying down the breast tissue spreads evenly over the chest wall and it is as thin as possible making it much easier to feel all the breast tissue.
2. Use your touch.
Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
3. Use different levels of pressure.
Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. A firm ridge in the lower curve of each breast is normal. If you’re not sure how hard to press, talk with your doctor, nurse or technologist at Breastnet. Use each pressure level to feel the breast tissue before moving on to the next spot.
4. Area to cover
Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the breastbone. Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collarbone (clavicle).
There is some evidence to suggest that the up and down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast and not missing any breast tissue.
The Visual Exam
While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it very difficult to examine.
This process represents an extensive review of the medical literature and input from an expert advisory group to the American Cancer Society. There is evidence that the woman’s position (lying down), area felt, pattern of coverage of the breast, and use of different amounts of pressure increase the sensitivity of BSE as measured with silicon models, and for CBE using patient models with known small non-cancerous lumps in their breasts.
Remember, if you find any changes, call Breastnet right away.