If your monthly breast self-exam happens in the shower — sporadically — and involves a quick once-over of your breasts, you may be missing some important elements of an effective exam. In truth, the best and most thorough breast self-exam you can perform is a multistep process, involving more than just the breasts themselves.
Here are five steps to a more effective exam, according to City of Hope breast cancer surgeon Laura Kruper, M.D., M.S., including a few you may not have heard before:
Step 1: Start by looking for differences between your breasts
Good breast self-exams should be concerned with both the look and feel of breasts. The look element should be performed while either standing or sitting in front of a mirror, with your clothes removed. Examine both breasts and look for:
Any unusual differences between the two breasts
Dimpling or indentations in the breast tissue
Redness, scaliness, or other changes to the skin or nipples that appear abnormal
Changes to your nipples, for example a nipple that is newly inverted or pulling in
Step 2: Put your hands on your hips, pull your elbows forward
Look for the same changes in the breasts from Step 1 — such as redness, lumps and indentations — this time with your hands resting on your hips while squeezing your elbows forward since this might bring out lumps that might not appear otherwise. Keep your hands on your hips and slowly swivel from side to side to catch possible abnormalities from more angles.
Next, lift your arms above your head to see if there’s any puckering or dimpling of the skin when you elevate them. “When you raise your arms, the mass, if there is one, stays there and the skin pulls in,” says Kruper.
The feel part of the breast self-exam should be done while lying down, with a pillow propping up your head and your arm resting behind it. With the opposite hand, take the first three fingers — index, middle and ring fingers — and use them to press down around the breast and surrounding area using circular motions. Using three fingers, rather than just one, keeps you from mistaking normal breast tissue for lumps. Increase the pressure you use with each pass around the breasts to ensure you are not just feeling superficial tissue.
Step 4: Examine the areas surrounding the breast
After examining your breasts, it is important to perform a check of the areas around them. Continue to use circular motions and increasing pressure as you move from the collarbone to the sternum and down below the breast. From the lower part of the breast, travel up to the area under your arm to look for any swelling in the lymph nodes. "What you’re looking for is something that stands out — something that feels like a pea, or a marble or a walnut," says Kruper. "Something that definitely feels different than the surrounding breast tissue."
Step 5: Perform the test at the same time each month
Be sure to do the breast self-examination the same time every month. If you are still menstruating, Kruper recommends you do the exam about seven to 10 days after your menstrual cycle, since at that time there will likely be fewer cycle-related changes in the breast tissue. Women who are postmenopausal can do the exam at any time of the month, as long it is around the same time each month.
Keep in mind that there is some debate about whether women should perform routine breast self-exams to find potentially cancerous lumps. Some of the concerns, according to recent studies, revolve around false positives and the fact that the exams may not necessarily improve a woman’s chances of survival.
As the debate swirls, Kruper maintains that women — and even men — who may be at higher-than-normal risk of breast cancer should to use the monthly self-exam as an opportunity to get more familiar with their breast tissue.
“The most important thing about a breast self-examination is to know your breasts,” says Kruper, who is also co-director of breast surgery service at City of Hope. “Many women detect breast cancers or breast lumps themselves and that can be the beginning of an important conversation with your doctor.”
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