Do’s and Don’t’s for a Proper Breast Self-Exam (BSE)

Dr. Mel, Physician Founder of the Cancer Prevention Movement says you can always remember proper BSE by using “1-2-3” and “3 by 3” as described in the “Do’s” section below…

DO's

1) Time your BSE properly –  

For menstruating women, you will want to perform BSE sometime between Day 2 and Day 10 of your menstrual cycle, where Day 1 is the first day of menstrual bleeding. The ideal time is Day 5, when both estrogen and progesterone hormonal levels are low and stable.  

For postmenopausal women, you will want to perform BSE on the same day of the month. This could be when your rent or mortgage is due, or some other monthly task that you expect to continue through at least age 75, and for as long as you expect to live for at least 5 years longer.  

For men, if you are at an elevated risk for developing male breast cancer, you should also perform BSE once a month. We recommend that you follow the same practice as for postmenopausal women.

2) Start your BSE with Inspection –  

Inspection should always be the first part of the BSE. For this part, you stand in front of a mirror with your hands on your hips. You will want to observe your breasts in 3 positions… 

1.  Standing Straight – There are 3 things you should look at while standing straight: 

First, stand straight and look in the mirror to notice if one breast is larger than the other. This is actually a very common trait, and is not abnormal, unless you notice a change from your normal baseline. Knowing your baseline is one of the main purposes of doing a regular BSE.  

Second, while still standing straightlook for evidence of skin thickening. This finding is often called “peau d’orange (French for “skin of an orange”). The earliest sign of inflammatory breast cancer is a new finding of skin edema (swelling due to accumulation of water). In the earliest form of skin edema, the pores of the skin appear more prominent because the skin around them is puffy, as is seen in an orange peel. In later forms of inflammatory breast cancer, the skin can become erythematous or red and can even feel warm to the touch. 

Lastly, while still standing straight, look for an inverted nipple or any of the other changes described in the graphic below. 

The most common change noted on inspection is actually a dimple, rather than a lump, because the action of gravity on an underlying tumor usually pulls on the tissue over it.

2.  Slightly Bent Over – If you see a dimple, try leaning forward with your hands on your hips to see if it persists or perhaps even deepens. Even if you don’t see any changes on initial inspection, it is a good practice to lean forward with your hands on your hips to see if any irregularities appear after you change position.

3.  Bent Over With Your Pectoral Muscles Flexed – Before standing straight again, roll your shoulders forward, gently flexing your pectoral muscles (“pecs”), to make sure no changes appear in this final position. 

3) Now Continue With Palpation

Lie down on a flat surface. If you are righthanded, raise your left arm over your head, and gently examine your left breast with the pads of the 2nd, 3rd, and 4th fingertips (index, middle, and ring fingers) of your right hand. If you are left-handed, raise your right arm over your head, and start examining your right breast with the same fingers of your left hand. In other words, start with your dominant hand to palpate (feel) your opposite breast. 

The breast is a tear-drop shape, with the tip lying in the axilla, or armpit. Therefore, it is important to examine all parts of the breast, including the armpit. There are several possible approaches to do this:  

    • Some people advise starting at the nipple and circling outward in a spiral, ending in the axilla (armpit) where the tip of the breast lies.  
    • Other people advise to start in axilla and cover the entire breast by moving up and down or back and forth until the entire breast covered.  

Whichever practice you choose, you want to always do it the same way. You also want to treat it as you would mowing the grass—you don’t want to miss any part of the lawn. To that aim, Dr. Mel advises that you don’t lift your fingers once you have started, and that you have your rows, columns, or spirals overlap slightly so that no area is missed. She also advises paying the most attention to the axilla and the part of the breast between the nipple and the axilla, as most breast cancers arise in this area, called the Upper Outer Quadrant of the breast.  

What exactly are you feeling for? Well, normal breast glandular tissue is irregular, and the normal feel of the breast is basically a collection of soft lumps. Because these lumps represent milk glands and ducts, if you are pregnant or lactating, the lumps will naturally feel more prominent. Therefore, the primary purpose of doing a regular BSE is to know your baseline and report something that has changed. If at any time, you feel something that is firm, like a small rubber ball that has lost its smooth edge, then you will want to report that to your doctor, especially if it persists over 2 or more menstrual cycles. Sometimes persistent lumps are cysts or benign fibroadenomas—not everything is cancer. In fact, 9 out of 10 times findings on BSE are not cancerous. In any case, it is possible to perform an ultrasound of a persistent lump to determine if a biopsy will be necessary to rule out cancer.  

The last step before switching sides is to gently squeeze your nipple with your opposite hand to make sure that there is no discharge. If you are pregnant or breastfeeding, then discharge will be expected; otherwise this would be an abnormality to report to your doctor.  

Now repeat the Palpation exam on your other breast using your nondominant, opposite hand. Remember, cancers that are found at an early stage are curable, so it is worth being vigilant. 

Here is a summary of the most important things to remember for the Palpation part of the BSE:

  1. Proceed like you’re mowing the lawn — you don’t want to miss any section of grass!
  2. Pay a lot of attention to the Upper Outer Quadrant (the area between the nipple and the armpit). 
  3. You’re not done with each side until you check for nipple discharge

Remember that not everything you find is cancer, but if something you see or feel persists for 2 or more menstrual cycles, or you are postmenopausal, you should get it checked out!

DON'TS

Do NOT put off doing BSE. 

If you are female age 25 or older, you should be doing this once a month. If you are at high risk for developing breast cancer, or if you are also age 40 or older, you also should be having regular breast imaging. Recommended breast imaging can include mammograms, ultrasounds, and/or MRI. To determine which type of breast imaging you should have, how often to have it, and when you should start, you need to know your risk. You can start understanding your risk by taking our Know4No™ quiz.  

Do NOT forget to do BSE regularly.

The more you know how your breasts typically look and feel, what we call your Baseline, the more likely that you will be able to discover a cancer, should you ever have one, early.  

Do NOT forget to do the Inspection part of BSE. 

Dr. Mel recommends doing the Inspection part first, as it will influence you to feel more carefully in that area during the Palpation part. 

Do NOT approach the practice BSE with fear.

If you find something, 9 out of 10 times it will be benign, but in the 1 out of 10 times that it could be cancer, you will more likely have caught it early because you chose to be proactive.  

Final point: The first step to having No Cancer is to Know Your Risk.

LADIES

If you are a female at high risk for developing breast cancer, you will still only want to perform BSE once a month. Cancers are usually slow growing, and if you check too often, you can miss a subtle change. That being said, if you are at high risk for developing breast cancer, your other screening exams will be  

  • different (ie. not just mammograms),  
  • start earlier (ie. as early as age 25, depending on your risk profile), and 
  • will be performed more frequently (ie. as often as every 6 months, depending on your risk profile.  

To determine your breast, and other cancer risk, schedule an Outsmart Cancer Consultation today. 

GENTLEMEN

If you are a male with a family history of breast, ovarian, melanoma, prostate, and pancreatic cancer, you may be at increased risk for developing male breast cancer. Make sure to schedule your Outsmart Cancer Consultation to determine if you should be doing BSE too. We also have a special article on Male Breast Cancer.

CANCER PREVENTION MOVEMENT

Our intention at the Cancer Prevention Movement is to empower you with the knowledge of how to best take charge of your health in a manner to allow you to optimize your chances of living a cancer-free life. Feel free to share this article with your friends and loved ones, so they may benefit too!

For more information about breast cancer, see our Breast Cancer Fact Sheet

 

 

Disclaimer:  The purpose of this article is for general health education. It is not meant to constitute medical advice.