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Breast Cancer
Breast Self Examination
Breast self-examination (BSE) is a very important part of every
adult woman’s personal health regimen. Many physicians and cancer
organizations recommend that BSE be performed once each month
beginning at age 20 and should continue each month throughout a
woman’s lifetime. In addition to BSE, adult women should receive
regular physician-performed clinical breast exams. The American
Cancer Society recommends women 40 years of age receive a screening
mammogram every one to two years. Beginning at age 50, mammography
should be performed every year.
The Best Time to Perform Breast Self-Exam
Menstruating women: Hormonal changes due to the menstrual
cycle may make the breasts more lumpy or swollen. Women who are
menstruating should perform breast self-exam from a few days to
about a week after menstruation (period) has ended, when breasts
are usually less tender or swollen.
Women who are no longer menstruating: should do their BSE
on the same day every month. Try to pick a day that is easy to
remember, such as the first or fifteenth of every month, and make
that the day each month for breast self-exam.
Women using oral contraceptives: are encouraged to do
their BSE each month on the day they begin a new package of pills.
Breast Changes and Warning Signs To Watch for
During Breast Self-Exam:
- Any new lump or hard knot found in the breast or armpit
- Any lump or thickening that does not shrink or lessen after
your next period
- Any change in the size, shape or symmetry of your breast
- A thickening or swelling of the breast
- Any dimpling, puckering or indention in the breast
- Dimpling, skin irritation or other change in the breast skin
or nipple
- Redness or scaliness of the nipple or breast skin
- Nipple
discharge
(fluid coming from your nipples other than
breast milk), particularly if the discharge is bloody, clear and
sticky, dark or occurs without squeezing your nipple
- Nipple tenderness or pain
- Nipple retraction: turning or drawing inward or pointing in a
new direction
- Any breast change that may be cause for concern
If any of these changes are noted, women should see their
physicians as soon as possible for clinical evaluation. However, in
the majority of cases (80%), breast lumps and changes are not
cancer. Women should not allow their fear of breast cancer keep
them from telling their physician or healthcare provider about a
lump or change they have found.
BSE Method While Standing in Front of a Mirror
Because the
upright position can make it easier to check the upper and outer
portions of the breasts and armpit, breast self-examination (BSE)
should be performed standing up in addition to lying down. Looking
(inspection) should take place in front of a mirror in a well-lit
area. A tall dressing mirror is often best. While standing in front
of a mirror, undress down to the waist.
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Place the
arms at the sides. Check the breasts for any changes in size,
shape or position, dimpling or puckering of the skin, pushed-in
or misshapen nipples, other changes in the nipple, redness,
swelling or other irregularities. Then, repeat this process
with the hands on the hips, pressing firmly to flex the chest
(pectoral muscles). Bend forward with the hands on the hips and
note any irregularities. |
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Raise the
arms overhead or put the hands behind the head. Turn to each
side to check the breasts in profile. Note any changes
in symmetry between the right and left breast. Remember, it is
often normal for women to have one breast that is larger or a
different shape than the other. |
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Examine
each breast separately and feel for any new lumps, changes, or
irregularities. Use the pads of the fingers, not the tips, and
practice the patterns of examination described in the above
section (up and down line, spiral, wedge pattern). The nipple
should also be examined during this time. First, squeeze the
nipple and check for any discharge (see section below for more
information on
nipple
discharge). Then push the nipple deep into the hollow
beneath it. Note any unusual resistance, hardness or lump
beneath the nipple. |
During the standing portion of the exam, the
lymph
nodes in each armpit and surrounding areas under the arm should
be carefully examined. Lymph nodes are normally about the size of
kidney beans. Sometimes the lymph nodes may be enlarged by a
non-cancerous infection. Occasionally, lymph node enlargement may
be caused by a cancerous process. As with any breast or nipple
changes, women should report any lymph node changes or enlargement
to their physicians.
BSE Method While Lying Down
In addition to standing, breast self-examination (BSE) should
also be performed while lying down. Women should use the pattern of
examination described in the above section and should ask their
physicians if they have questions about performing BSE. The
video
program also shows the proper BSE technique.
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Lie down
with a pillow or folded towel under the right shoulder and
place the right arm behind the head. Check the entire breast
and armpit area using the pads of the first three middle
fingers on the left hand to feel for lumps, changes, or
irregularities in the right breast. Press firmly enough to know
how the breast feels. A firm ridge in the lower curve of each
breast is normal. The exam should then be repeated on the left
breast, using the finger pads of the right hand (the pillow or
folded towel should also be moved under the left shoulder at
this time). |
 While
performing BSE lying down, the nipple should also be checked for
any changes. After making an initial examination, gently squeeze
the nipple to check for any discharge of fluid. Note any changes in
appearance, discharge (including the color and whether the
discharge occurs spontaneously or by squeezing), or cracking.
Nipple fluid that is green or yellow is usually normal. Nipple
fluid that is bloody, dark or clear and sticky is considered
abnormal (although most suspicious nipple discharges are found to
be caused by non-cancerous conditions such as
papillomas). In approximately 10% of all cases, nipple
discharge is due to a cancerous lesion. In women less than 30 years
of age, less than 10% of nipple discharge is due to cancer.
Nevertheless, any persistent nipple discharge should be reported to
a physician for clinical evaluation.
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