Because most breast problems are discovered by women themselves, performing breast self-examinations can play an important role in the early detection of breast problems.
If you find an unusual lump or other symptom that persists past your menstrual cycle, call your doctor right away – even if you are not sure if you have detected a change. If you no longer have menstrual cycles, report any persistent changes (lasting 10 days) to your doctor.
Your gynecologist, family doctor or general practitioner will help you or refer you to a physician who specializes in breast disease. As you read the following descriptions and look at the photos for each step, mark any sections that are unclear and ask your doctor for clarification.
From puberty onward, women should perform a breast self-exam each month. The best time to perform an exam is seven to 10 days after the start of your menstrual period, when your breasts are less likely to be swollen or tender. After menopause or hysterectomy, it is best to do a breast self-exam on the first day of the month or on the first day of hormone replacement therapy. Of course, the key to success is to do your self-exam every month.
Choose a time when you can do a thorough, relaxed exam, in a place where you will not be disturbed. Do not try to fit the exam in during a hectic time when you will have trouble concentrating.
A breast self-exam involves three simple steps.
1. Checking Your Breasts in the Mirror
Stand in front of a mirror in a well-lighted area. Look for any changes in the size or shape of your breasts, or any unusual puckering, dimpling, scaling or change of color in the skin.
Pay close attention to the nipple’s size, color and direction. Push each nipple gently inward, forming a small “well.” Make sure the nipple pushes in easily and returns to its normal position. Call your doctor if you notice any hardness, soreness, resistance or change in nipple direction. Continue looking in the mirror. Raise your arms and clasp your hands behind your neck. Push forward with both hands, flexing your chest muscles. As you hold this position, look carefully for dimples or lumps. Now relax and look again; your breasts should look the same whether your muscles are tense or relaxed.
2. Feeling Your Breasts Standing Up
You may find that the shower or bath is a convenient place to do this part of the breast self-exam. In the shower, start with a soapy lather so your hands will glide smoothly over your skin. If you are doing the self-exam elsewhere, you may want to use a moisturizer.
As you go through the steps, keep your fingers flat and relaxed, feeling with the flat surface of your three middle fingers. Fingertips can push a lump away before you notice it. Raise your arm over your head and examine your left breast with your right hand.
There are two methods you can use to perform the second and third steps of the exam: the spiral method and the grid method. Whatever method you choose, first use light then deep pressure to examine each breast.
Use either of the following two methods (spiral or grid) to examine your breast tissue. Pick the method that is most comfortable for you.
Start your self-exam in the armpit area, then move to the collar bone, and finally to the breast. Moving your hand in a small circle, start at the outside edge of your breast and move around its entire edge. Feel for any unusual lumps or symptoms. Make at least three circles until you reach the nipple. Go over each breast twice, once with light pressure and once again with deep pressure.
With the grid method, you examine your breasts in a checkerboard pattern, from collar bone to bra line and armpit to breastbone. Starting at the left edge of the grid, make a dime-sized circle with the flat surface of your fingers, first with light pressure and then with deep pressure. Move a finger-width away and repeat. Take your time and cover the entire area of the breast, armpit and collar bone.
Use gentle, even pressure to check for tiny lumps near the surface of the skin.
Then use deep, firm pressure to probe all the way back to the ribs, especially when you are lying down.
3. Feeling Your Breasts Lying Down
Do the third step of the self-exam lying down. Put a folded towel or pillow under the middle of your back for support; this also helps to distribute your breast tissue evenly. You may want to use a moisturizer to help your hand glide smoothly.
Repeat the manual exam using the spiral or grid method, using both light and deep pressure. Remember to check up on your collar bone and under your armpits for any unusual signs in your lymph nodes.
As you do your breast exam each month, you will begin to recognize what is normal for you. As you become familiar with the structure of your breasts, sketch out any defining features in the Notes section at the back of this booklet and refer to them each month as you begin your self-exam.