Breast Self-Exam (BSE)

Like many other screening guidelines recently, the Breast Self-Exam (BSE) has come under some scrutiny, with some experts suggesting it may not provide any benefit in breast cancer detection and treatment. My views are concurrent with many other experts, like those at BreastCanger.org, who believe that BSEs are an important and useful tool in the prevention and diagnosis of breast cancer.

It is true that mammograms are able to detect cancers before a lump is ever felt, but 15% of breast cancers are not detected by a mammogram. If you feel any changes to your breast tissue, it is important to alert your doctor. 20% of breast cancers are first detected through a physical examination, like the BSE. This week, we will go over how to do a BSE, how often, and the benefits they provide.

Become Familiar with Your Breasts

At a young age (around age of your first period), it’s important to begin familiarizing yourself with your unique breast tissue. This is the best way to detect if you’ve had any abnormal or unusual changes to your tissue. Younger women tend to have dense breasts that feel “lumpy” to them upon examination. This should not be confused with a dangerous lump or mass. The breasts are naturally composed of different glands and a breast will not feel completely smooth and soft like pudding in a plastic bag. The difference between normal breast tissue and a potentially dangerous mass is that a mass will feel like a hard rock under your skin. Because the American Cancer Society has determined that BSE do not reduce mortality from breast cancer, they have deemed the BSE an optional screening tool. Despite this, I would still encourage all women to conduct breast examinations once a month at home.

The Exam

BSE are best done every month at the end of your period when breasts are less tender and sensitive. By starting at a young age, you are able to become familiar with your breasts and will be able to determine any changes as they arise. By age 20, breasts will have stopped changing and BSE should be conducted monthly. Breast tissue also extends up into your underarms, so it is important to be aware of this when doing your monthly breast check. The underarm area is also the location of the nearest lymph nodes to your breasts and would be the first place breast cancer would spread to if it were present.

Abnormalities to check for:

• New lump
• Thickening or swelling of breast tissue including in the underarms
• Dimpling or puckering of skin
• Redness, rash, or irritation of skin on and around breasts
• Inversion of nipple
• Nipple discharge, especially bloody (not including breast milk)
• Change in breast size or shape
• Any abnormal pain (though most early stage breast cancers do not cause pain)

Step 1: Mirror

Observe. Look in the mirror and check for any noticeable physical changes. Start with your hands at your sides, then observe again when your hands over your head. If you observe any dimpling of the skin, bulging, changes to the nipple, redness, or other distortion, you should follow up with your gynecologist or primary care doctor. It is normal for breasts to be slightly different sizes but any abnormally large differences in size, especially sudden changes, should also be addressed by a doctor.

Step 2: Shower

The easiest place to examine is in the shower unless you are very large breasted, in which case the best way to examine your breasts is in Step 3. Begin by lathering your hands with soap and imagining your breast as a pie divided into wedges. Using your fingertips, begin on the outside of the breast in one pie wedge and slide your fingers inward toward the nipple. Then move into the next pie wedge, and repeat. Continue in a circle until the whole breast and all its pie sections are complete.

Next, with a relaxed arm by your side, check all the way into your underarm where more breast tissue is located. It is important to keep your muscles relaxed in order to feel deeply into this underarm space. Many people make the mistake of examining this area with their arm over their head. This is a problem because it naturally causes those muscles to become firm, inhibiting a proper exam.

Finally, press across your nipples to feel for any lumps hiding there. Again, a lump should feel hard like a rock. Normal glandular breast tissue should not cause any concern. Outside the shower and with dry breasts, you should gently squeeze your nipple. There should be no discharge from the nipple. If any is present, you should follow up with your doctor.

Step 3: Bed

The last way to examine your breasts is by lying down on your back. This allows you to get another feel for your breasts. Follow the same motions in step two to check your breasts once more. If you have very large breasts, when lying on your back, you should tilt your body slightly to center the breast you are checking on the chest wall then repeat with the second breast.

If You Feel a Lump:

Do not panic. 80% of lumps are not dangerous. Still, it is important to visit your doctor for further evaluation and to be consulted about the next steps you should take. There are several different methods with how to proceed after a lump is found and may include a mammogram, ultrasound, MRI, a referral for a biopsy, or more depending on your unique needs.

Breasts are not static and often go through slight changes throughout the month and depending on the time of your menstrual cycle. If prone to cysts and tender breasts, caffeine will increase these symptoms. Medications, especially hormones, like birth control pills or hormone replacement, can add to sensitivity and gland swelling. This is why it is so important to become familiar with your breasts and note that while small shifts are normal, any unusual changes should be addressed. While most breast lumps are benign, 40% of breast cancer diagnoses occur due to the detection of a breast lump.

Conclusion

The BSE is an important tool for home health screenings. Just as you floss your teeth to encourage tooth health, you should consider checking your breasts to encourage breast health. 40% of diagnosed breast cancers are actually due to the detection of an abnormal lump.

Once a month, after your menstrual period, you should conduct a BSE from the age of first menstruation on. Familiarizing yourself with the map of your personal breast tissue is the best way to understand when something new and abnormal has occurred. Breasts should naturally feel glandular while a mass or lump will typically feel hard like a rock. Other abnormalities that you should consult a doctor for are abnormal nipple discharge, swelling or change in breast shape, redness or irritation of breast skin, inversion of the nipple, and more. Put simply, any abnormal or sudden changes to a breast should be followed-up with by a doctor. Thankfully, the majority of breast lumps are benign. Regardless, the BSE should be considered an important part of a woman's health routine.

References:

Self
Breast Self-Exam. NationalBreastCancer.org.
Breast Self-Exam (BSE). BreastCancer.org. 2014.
Breast Cancer Screening for Health Professionals (PDQ). National Cancer Institute. 2015