Breast cancer is a concern that affects millions of women's lives, and it's normal to feel uneasy thinking about it. Every October, during Breast Cancer Awareness Month, we’re reminded of just how important it is to keep this conversation going.
Whether or not you know your family’s medical history, or even if cancer isn’t something you’ve faced personally, the thought of breast cancer can still feel overwhelming. It’s a time to break down the fears, share knowledge, and focus on prevention and early detection. In this article, we invite you to join us in learning the essentials of breast self-examinations.
How common is breast cancer?
Breast cancer is the second most diagnosed form of cancer in women and accounts for 30% of all new cancer cases in U.S. women annually. Additionally, about one in eight U.S. women will develop invasive breast cancer in their life.
Suffice it to say, you probably know someone who has been affected by breast cancer, whether through their own experience or that of a family member or friend. Breast cancer can also affect men, with about 1 in every 100 new breast cancer cases in the U.S. discovered in a male body.
That said, about 66% of these new cases of breast cancer are “diagnosed at a localized stage—before cancer has spread outside of the breast,” which means they are much easier to treat.
While experts have debated the efficacy of self-checking for cancer detection, many believe that self-examination can (alongside other screening methods such as annual “well woman” OBGYN exams and annual or biannual mammograms beginning at age 40) increase the chances of early detection and more effective treatment options.
What is self-examination, or “self-checking?”
A self-examination, more casually known as “self-checking,” is when you examine yourself and your own breast tissue thoroughly to check for lumps or bumps that feel out of the ordinary. You know your body better than anyone else, so it makes sense that you can and should be your first line of defense when it comes to abnormality detection.
When should I self-exam?
Experts recommend a monthly self-exam in addition to exams with your OBGYN, and they should include a breast exam as part of your annual exam. Some experts also recommend that you self-exam several days after your period ends when your breasts are least likely to be swollen and tender. However, if you no longer have a period or do not menstruate, you can complete the exam on your own time and at a time that feels most comfortable to you, though choosing an easy-to-remember day (like the first or the last of the month) can be helpful.
Since life gets busy and we have a tendency towards modern distractions, we do recommend doing all the steps at one time—whether that is in the morning on the first of the month. A monthly cadence will not only help you get used to the self-exam, but you’ll learn the intricacies of your breasts and become better attuned to noticing if something ever does appear that is out of the ordinary.
As a note, if you are under 40 and have a family history of breast cancer or other genetic markers that indicate a higher-than-average risk, you should speak with your doctor about their recommendations for annual or biannual professional screenings in addition to self-checking.
How do I perform a breast self-examination?
While it may seem daunting given the facts shared above, a self-examination is pretty simple once you know the steps and will become easier each time you do it.
Be aware of what your breasts normally feel like, where you are in your menstrual cycle, and if you are pregnant or taking any hormones as that can affect how your breast tissue feels (especially if tender or swollen as related to your cycle or hormones). Normal breast tissue can have a variety of textures, including fat, glands, and connective tissue, and many women have small lumps and bumps as a part of their healthy breast tissue.
When it times to conduct your examination, you’ll need to be nude from the waist up, have a mirror handy where you can clearly see yourself, somewhere to lay down, and good lighting so you can carefully examine yourself. We’ve broken the exam down into four easy-to-remember steps:
1. Take a good, long look
With your hands on your hips, visually examine your breasts. You’re looking to see that your breasts are their usual size, shape, and color. If you notice any of the following, we advise bringing them to your doctor’s attention:
- Visible distortion or swelling
- Dimpling, puckering, or bulging of the skin
- Changes to your nipple position
- An inverted nipple (where it looks pushed in instead of pointing out like usual)
- Redness, soreness, rash, or swelling
2. Look again
This time, raise your arms and clasp your hands above your head, and repeat the same visual examination. Has anything changed now that your physical position has shifted your breast tissue and allowed you a new view?
Continuing your visual examination, look to see if there is any fluid coming out of either or both nipples. You’re looking for an unusual fluid with a watery, milky consistency, something yellowish, or even blood. If you see any sign of unusual fluid you should bring this to the attention of your doctor.
3. Feel it out
First, you’ll want to do your tactile examination while lying down. Make sure you have a flat area to lay on—such as your bed or sofa—and a pillow to keep your head comfortable.
You can start with either side, but you’ll want to use the opposite hand to feel the breast—for example, use your right hand to feel your left breast, and your right hand to feel your left breast. For the breast you are examining, lift your arm up and rest your forearm behind your head (so if you are feeling your right breast with your left hand, you’ll want your right arm comfortably tucked behind your head).
With each breast, you want to make sure you completely feel the entire breast and underlying tissue, “from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.”
You can begin anywhere you like, but you want to make sure the pattern you follow covers the entire breast. We recommend following the same pattern on both breasts so you know you didn’t skip anything.
There are different layers of breast tissue and different levels of pressure to use for those areas. Below are some tips on how to examine, and you can use this as a starting point and follow the order that feels right to you:
- You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast.
- You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn.
- Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you've reached the deep tissue, you should be able to feel down to your ribcage.
4. Once more, with (more) feeling
Like you repeated your visual examination, you’ll repeat your physical examination—but this time standing up or sitting upright. You can do this pretty much anywhere in your home you feel comfortable. Some women find it even more helpful when their skin is wet and it is easier to slide over, and can even incorporate this into your “everything shower” routine.
I found a lump that doesn’t feel normal; what do I do?
Don’t panic! Remember, just because you feel something different doesn’t mean it's “bad.”
It’s extremely common to find a lump, and most lumps are not cancerous. To break it down in numbers, about 80% of all lumps are non-cancerous and benign, up to 25% of them are just fluid-filled cysts, and only 10-20% turn out to be cancerous. Proactive examination helps to catch malignant lumps sooner to ensure more effective treatment.
It's important to note that women can’t tell if something is cancerous just by how it feels, or by its size. Not all lumps feel the same, but here are some examples of what you might be feeling:
- A hard lump or a soft, “squishy” lump
- One that feels sore or painful (on its own or when pressure is applied), or perhaps no pain at all
- A lump that is mobile, meaning you can move it with your finger, or one that feels fixed in place and doesn’t move with the pressure
- A lump in the armpit or above the breast mound
If you do notice something, it’s important to see your doctor so they can do a physical examination and, if necessary, recommend and refer you to additional screening techniques such as a mammogram or ultrasound.
During your exam, you’ll want to share the information you discovered, such as:
- When you first felt the lump
- What, if any, physical changes you noticed in your breasts or if there is any unusual discharge
- Skin changes in tone or texture such as rash, dimpling, or puckering
- If you have ever had an injury to the breast
- What medications, supplements, and/or hormones you may take
- Family history of breast cancer and other cancers if you have this available
Armed with modern exam tools and expert knowledge, your doctor will walk you through the process of determining the nature of your lump and any necessary next steps.
What's next?
You keep on keeping on! Continue to be your own advocate and take charge of your health and wellness. It can also be empowering to learn about the courageous women impacted by this disease, both within and beyond your own community. Seek out opportunities to support and advocate for those who have faced greater challenges in their health journey–you never know what you’ll learn along the way.
You can access more research about Breast Cancer at https://www.breastcancer.org/, and explore ways to contribute to celebrations of courage and fundraising to support research throughout October via the Breast Cancer Research Foundation and many other philanthropic organizations.
A note on sex and gender: Sex and gender exists on spectrums, and this article uses terms like “male” or “female” to refer to sex assigned at birth. Learn more.
