Julian Birchman, HelloGiggles
October is Breast Cancer Awareness Month.
According to the National Breast Cancer Foundation, 1 in 8 women in the United States will develop breast cancer in her lifetime. That makes up about 12% of American women. It’s the most common form of cancer among females worldwide (aside from some skin cancers), and it can happen to anyone, regardless of family history. That's because while doctors are continuing to do research around breast cancer, they have not yet pinpointed a specific root cause for why some women develop it. What they do know is that certain lifestyle-related risk factors, such as what you eat and how much you exercise, can impact your chances of developing breast cancer as well as certain hormones and whether or not you have a family history. To stay informed about potential breast cancer risks, early detection is key.
The good news is that you know your breasts best, and one easy way you can keep on top of any oddities—particularly if you know you’re at higher risk—is to perform regular breast self-exams at home. We tapped two doctors to get the scoop on how to perform a breast self-exam, how often we should be doing them, and what we should be looking for. Here's what they had to say.
What is a breast self-exam?
“Breast self-examination is the actual systematic inspection of your breasts on a regular basis for the purpose of detecting breast cancer," explains says Nicole Sparks, M.D., an OB-GYN and brand ambassador for The Hello Cup.
According to The American College of Obstetricians and Gynecologists (ACOG), clinical breast examination (the kind performed in the office with a physician during your well woman exam) is recommended every one to three years in women 25-39 years old and annually for women aged 40 years and older.
Dr. Sparks tells us that recommendations for breast cancer screening with mammography are based on a patient's individual risk factors, including a family history of breast or ovarian cancer, gene mutations, age, and smoking. If you have any of these risk factors, earlier screening is likely recommended.
How often should you give yourself a breast exam?
“Self breast exams should be performed once a month, as nearly 40% of all breast cancers are detected by patients at home,” says Huong Nghiem-Eilbeck, M.D., M.P.H., a board-certified OB-GYN with the birth control delivery service Pandia Health.
According to Medlineplus.gov, the best time to do a monthly breast self-exam is about three to five days after your period, since your breasts are less likely to be swollen and tender due to hormones at this time.
These regular exams are important because, according to Dr. Nghiem-Eilbeck, some breast lumps seem harmless as they are not visible or do not cause pain. Plus, many women do not see their doctors for at least one year at a time, while others may miss their suggested yearly mammograms.
However, "breast self-examination is different from breast self-awareness," says Dr. Sparks. She tells us that monthly breast self-examination is not always recommended in average risk-women because of the potential harm of false-positive results and the anxiety and risks associated with it. "However, we do recommend breast self-awareness, meaning you should be aware of what is normal for the appearance and feel of your breasts.” According to Sparks, every woman should get familiar with her breasts, keeping a close eye on normal shape, size, color, and appearance so that if any changes crop up, you know to contact your healthcare provider.
Not sure what's abnormal? Dr. Nghiem-Eilbeck says that “breasts will not be perfectly symmetrical, but they should not change much, so any skin color changes, dimpling or puckering of the skin, discharge or blood from the nipple, or any new lumps can be noticed with a self-exam."
According to her, the more you do these, the more you’ll be able to discern the difference between what the chest wall (bumps from ribs) feels like versus normal breast tissue.
How do you complete an at-home breast self-exam?
Start in the shower.
While you’re in the shower, the National Breast Cancer Foundation recommends using the pads/flats of your three middle fingers to check the entire breast and armpit area by pressing down with light, medium, and firm pressure. “I tell patients to imagine they are mowing a lawn and examine the breasts in a methodical fashion from outside to inside so you do not miss any key areas,” says Dr. Sparks.
The easiest way to do this is to position yourself with one arm raised above your head and work your way from the chest plate to the armpit. The wetness from the shower will help your hand glide more easily over the entire surface of your breast, ensuring all areas are checked.
Start with one breast, then move to the other.
Check 'em out in the mirror.
Next time you're hopping out of the shower or about to get dressed, take a moment to visually inspect your breasts with your hands by your sides. They don't need to be totally symmetrical (in fact, most women's breasts are not), but "note any changes, such as dimpling of the skin or inversion of the nipples, especially on one side" says Dr. Sparks. Then, repeat the exam with your hands on your hips. Guidance from the NBCF says to "rest your palms on your hips and press firmly to flex your chest muscles." This allows you to notice any changes in the breast shape or contours.
Feel around lying down.
The final way to give yourself a thorough breast self-exam is by lying down. Dr. Nghiem-Eilbeck walks us through the process: “Use the ball of the middle three fingers to move in small circular motions, pressing all the way down the chest wall in an organized fashion. Start in the underarm area, then inch the circular motion across all four quadrants to ensure you have covered the entire breast area.” Repeat these steps on the next breast.
This position lets you feel parts of your breast that can be difficult to examine in other positions, like when you're standing up.
What are you looking for?
Just like a clinical breast exam done in a doctor's office, the purpose of a self-exam is to look for any concerning changes in your breasts.
If you’re not sure what to feel for, Dr. Nghiem-Eilbeck says this: “Some lumps feel like balls under the skin that move around, while other lumps may not be as mobile.” Additionally, the Susan G. Komen Foundation lists warning signs as:
- a lump, hard knot, or thickening inside the breast or underarm area
- swelling, warmth, or darkening of the breast
- change in the size or shape of the breast
- dimpling or puckering of the skin
However, not all lumps are considered cancerous and concerning. In fact, 8 out of 10 lumps are not cancerous. Common types of benign breast lumps include abscesses (pockets of pus that cause inflammation), cysts (fluid-filled sacs within the breast tissue), and fibroadenomas (solid, smooth, firm, noncancerous (benign) lumps) that you may feel. These can be painful or non-painful, depending on the type, and only your healthcare provider can diagnose them.
That's why “any new lumps, regardless of age, should be brought to [a] doctor in case further testing should be done, such as an ultrasound or mammogram,” says Dr. Nghiem-Eilbeck.
If you are experiencing breast pain (dull ache, tenderness, burning sensation, sharp pain, or just a sense of uncomfortable fullness), try to determine whether the pain is cyclical and typically happens around your menstrual cycle. If so, it could be caused by hormones. However, if the pain is not clearly associated with your menstrual cycle, lasts more than two weeks, is just in one spot, or keeps getting worse, talk to your doctor.
What happens if you find a lump?
If you find a lump while performing a self-exam, try not to panic. Call your healthcare provider (for example, your gynecologist, primary care doctor, or a nurse practitioner who works with your gynecologist or primary care doctor). According to breastcancer.org, "At an appointment to evaluate a breast lump, your doctor will take a health history and do a physical exam of the breast and will most likely order breast imaging tests."
Your family health history is also important to know, as breastcancer.org reports: "You are substantially more likely to have a genetic mutation linked to breast cancer if you have blood relatives (grandmothers, mother, sisters, aunts) on either your mother's or father's side of the family who had breast cancer diagnosed before age 50." If further testing is needed after the evaluation of the lump via a mammogram and ultrasound, your doctor may send you to get further imaging with an MRI or MBI and/or refer you to a breast specialist for further evaluation.