Breast cancer is certainly well known to the public, and its research has been well funded through charity dinners and the popular “Race for the Cure” events. 

Annual imaging through mammograms, sonograms, or even MRI’s have become routine for women over the age of 50.  For reasons of family history or simply lumpy breasts, many women will have these tests starting at age 40 or earlier. In addition, women will also have their breasts checked by their doctors as part of their annual physical examination. 

But in the months between images and doctor visits, early detection begins at home.  However, in spite of all this good public awareness, my patients tell me they are still somewhat unclear about “if, when, and how” to perform their own self-exams.

Here is a simple review:

1.       (“…if”):  Many articles are now surfacing that suggest self-exams of the breast are merely “optional”, and at best, really not very helpful.  I have a problem with this “hands-off” approach, in the same way I would respond to an “expert” article dismissing self-examination of the skin to check for changing moles.  In just the same way as the skin cancers, changes in basic structure beneath the skin can be followed by patients between their visits to the doctor.  In a recent study of breast lump patients that came to surgery, as many as 40% were first picked up by manual exam, not just by high-tech machines.  As I tell my patients, if a new lump appears next month, they should not wait eleven more months for me to find it at their routine physical examination. 
 
2.       (“…when”):  Most women of menstruating age will note breast lumps and tenderness to some degree, peaking just before their next period.  For this reason, it would make sense to focus on examining the breasts at the beginning of each new cycle.  For post-menopausal women, just pick the same day each month, say the first, and make that the benchmark day of self-examination.  To be sure, there is nothing wrong with weekly or daily routines, but the monthly check removes some of the ebb and flow factors of hormonal levels.

3.       (“…how”):  I will include a written version of the breast self-exam below.  But, I would suggest three additions:

• Perform the exam in the bath or shower, in addition to in front of a mirror.  When the skin is slippery on the surface, it is far easier to detect masses beneath.
• Lay the flat of your hand against the rib cage, and roll your fingertips against the breast tissue.  Don’t squeeze or point your finger-tips perpendicular to the ribs.
• PLEASE check the collar bone, as well as the arm-pit (axilla).  If any lumps appear above or below the collar-bone (clavicle), then these (as well as axillary lumps) could represent primary breast issues.

References:

MayoClinic: Breast Self-Examination

In conclusion, each woman should become an expert in her own breasts, to have the earliest chance of catching breast cancer before it spreads.