Breast Self Exam

Breast self-exam (BSE) is a tool that may help you become familiar with the way your breasts normally look and feel. Knowing what is normal for you may help you see or feel changes in your breast. If you notice any of the warning signs of breast cancer listed below, see your health care provider right away.

Lump, hard knot or thickening
Swelling, warmth, redness or darkening
Change in the size or shape of the breast
Dimpling or puckering of the skin
Itchy, scaly sore or rash on the nipple
Pulling in of your nipple or other parts of the breast
Nipple discharge that starts suddenly
New pain in one spot that doesn’t go away

Adapted from National Cancer Institute, American Cancer Society and Centers for Disease Control and Prevention.

Breast lumps or lumpiness

Many women find that their breasts feel lumpy. Breast tissue naturally has a bumpy texture. There is also a great deal of individual variation. For some women, the lumpiness is more pronounced than for others. In most cases, this lumpiness is no cause to worry. If the lumpiness can be felt throughout the breast and feels like your other breast, then it is probably just normal breast tissue.

Lumps that feel harder or different from the rest of the breast tissue (or the tissue of the other breast) or that feel like a change are a concern. When this type of lump is found, there is more risk that it may be breast cancer. Some benign breast conditions though (such as cysts and fibroadenomas) can cause similar changes.

See your health care provider right away if:

You find a new lump or change that feels different from the rest of your breast.
You find a new lump or change that feels different from your other breast.
Feel something that is different from what you felt before.

If you are unsure whether you should have a lump checked, it is best to see your provider right away. Although a lump may be nothing to worry about, you will have the peace of mind that it has been checked.

Nipple discharge

Liquid leaking from your nipple (nipple discharge) can be troubling, but it is rarely a sign of cancer. Discharge can be your body's natural reaction when the nipple is squeezed. However, the following may be signs of a more serious condition, such as breast cancer:

Discharge occurs without squeezing the nipple.
Discharge occurs in only one breast.
Discharge has blood in it.
Discharge is clear (not milky).

Nipple discharge can also be caused by an infection or another condition that needs medical treatment. For these reasons, if you have any nipple discharge, you should see your health care provider right away.

Breast self exams as a tool for breast self-awareness

Breast self-exam does give women a chance to become more aware of their own bodies and play active roles in their health. Breast self-exam can help you learn what your breasts look and feel like so that you can notice any changes.

If you do breast self-exam, be sure to also get recommended mammograms and clinical breast exams as directed by your health care provider. Breast self-exam should not be used as a substitute for breast cancer screening tests.

How to examine your breasts:

Lie down and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.
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.

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. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you're not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.
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 chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (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, without missing any breast tissue.
Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the 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, or redness or scaliness of the nipple or breast skin. (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 harder to examine.

This procedure for doing breast self exam is different from previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman's ability to find abnormal areas.

It is recommended that you:

1. Know your risk

Talk to your family to learn about your family health history
Talk to your health care provider about your personal risk of breast cancer

2. Get screened

Ask your health care provider which screening tests are right for you if you are at higher risk
Have a mammogram every year starting at age 40 if you are at average risk
Have a clinical breast exam at least every 3 years starting at 20, and every year starting at 40

3. Know what is normal for you and see your health care provider right away if you notice any of these breast changes:

Lump, hard knot or thickening
Swelling, warmth, redness or darkening
Change in the size or shape of the breast
Dimpling or puckering of the skin
Itchy, scaly sore or rash on the nipple
Pulling in of your nipple or other parts of the breast
Nipple discharge that starts suddenly
New pain in one spot that doesn't go away

4. Make healthy lifestyle choices

Maintain a healthy weight
Add exercise into your routine
Limit alcohol intake