Written by Tiffany Woodus, MD/OBGYN (Obstetrician-Gynecologist)
Breast self-examination (regular, repetitive self inspection of the breast with the goal of detecting breast cancer) is no longer recommended by the American Cancer Society or the U.S. Preventive Services Task Force for the average risk woman. This is because we have found it can lead to increased risk for harm from false-positive test results and we have been unable to verify consistent evidence of benefit or improved outcomes. This essentially means women are identifying a problem where in fact, one does not exist, and are subsequently undergoing further imaging and procedures which are not without risks, only to find out everything is okay.
We do recommend educating average risk women about breast self-awareness which is being aware of the normal appearance and feel of the breasts so that if something changes a woman can notify her healthcare provider. Even though breast self-examination is no longer recommended, the frequency of self detection of breast cancer (~50% of breast cancer cases in women 50 years and older and ~71% of breast cancer cases in women younger than 50) provides a strong rationale for breast self-awareness in the detection of breast cancer.
Women should be educated about the signs and symptoms of breast cancer, such as pain, a mass, skin changes like dimpling or retractions, redness, or new onset nipple discharge. Women should be advised to notify their provider if they experience any of these changes.
If you choose to include breast self-examination as a part of your breast self awareness routine, here’s how I want you to approach it.
1. Prepare Yourself. Have a discussion with your provider to familiarize yourself with any particular instructions, techniques, or concerns specific to your situation.
2. Know the warning signs. Changes to be aware of include: a new lump in the breast or armpit, thickening or swelling of any part of the breast, bloody nipple discharge, skin changes such as inflammation, dimpling, or retractions, pulling in of the nipple or pain in the nipple area, any change in the size or shape of the breast, pain in any area of the breast. Promptly notify your provider if you experience any of these changes.
3. Perform the evaluation when your breasts are less likely to be tender or swollen to decrease discomfort. If you are menstruating, a good rule of thumb is to avoid the week prior to your period.
4. Visually exam the breast. Sit or stand in front of a mirror with your arms at your sides. Observe your breast with your hands on your hips and your arms raised above your head with your palms pressed together. Evaluate for the warnings signs we previously mentioned in each of these positions.
5. Touch yourself. This can be done sitting, standing, lying, in the shower, etc. The goal is to know yourself. Know your norm. Know your baseline so that if something changes, you will be aware and can notify your provider. Take your time. Be deliberate. Follow a pattern of your choosing. Some common examples included a railroad or radial type pattern. Slide your fingers along the skin to avoid missing any areas of the breast. Use a variety of pressure from superficial to deep in order to evaluate all the way from the skin surface to the chest wall.
Know that breast self awareness is not a substitute for your clinical breast exam or mammogram. The clinical breast exam is a breast exam performed by your provider that typically starts in your 20s and is performed every 1-3 years. The American College of Obstetricians & Gynecologists recommends beginning the mammogram at age 40 for the average risk women and then continuing the exam every 1-2 years.
It is also important not to panic if you notice any changes. Most breast changes or lumps we find are not cancerous. The breast tissue is dynamic and changes throughout the month in response to fluctuations in hormone levels.
The bottom line is spend some time getting to know yourself. Get acquainted with your girls. It is important. It saves lives. Doctor’s orders.
Touch yourself ladies. This is self care on another level.
Sources: ACOG, ACS, John’s Hopkins, Mayo Clinic
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