Breast cancer. We have all heard of it and likely know someone who has been diagnosed with it. We all think it will not happen to us, but the truth is, one in eight women has or will have breast cancer. It is important to catch breast cancer quickly and contact your primary care doctor immediately if you find an abnormality. Identifying breast cancer early could mean easier treatment, having more treatment options, and possibly removing the entire cancer before it spreads. The greatest risk is age, not genetics. As we get older, our risk increases. A monthly self breast examination could save your life!

Timing is everything. If you are still menstruating, the best time to perform your breast examination is during the week when you are not having your period, about to have your period or just finished your period. In other words, you don’t want your hormones fluctuating too much as this can change your breast size and tenderness. This varies from woman to woman. For some women, their breasts don’t change at all during their cycle, while for others, their breasts can get significantly fuller and heavier. Perform your breast examination the same time each month. If you are no longer menstruating, you can perform your exam monthly and keep track. Life gets busy, so set a monthly calendar reminder on your smart phone. Oftentimes, your general practitioner or gynecologist will perform well-women exams and breast examinations at your visit. However, this is only performed at their office annually at best and is not frequent enough to suffice for how often breast exams really should be performed.

There are many described methods for how to best perform your breast exam. You are palpating for a hard nodule that is at least 1 cm in diameter. This nodule likely is fixed and does not move, like a very hard pea. Raise your arm above your head on the side where you will be performing the breast exam. Take your other hand and press down firmly onto the opposite breast. When done correctly, it should be slightly uncomfortable and not like a massage at all. Potential discomfort is another reason to not perform your breast exam while menstruating.

In regard to examination patterns, my preferred method is the “lawnmower” technique. Your hand follows a zig-zag pattern up and down the breast from inside to outside in a very systematic manner. This method decreases the chance of missing any breast tissue. Make sure that you are compressing your breast tissue against your ribs. When you perform your exams enough, you will be able to distinguish what feels like rib and what is actually a hard nodule. It helps to also look up an anatomy illustration of a ribcage to visualize what you are feeling. Your breasts are glandular soft tissue and subcutaneous fat sitting on muscle and the ribcage. Some people like the “whirlpool” method where they start from the nipple and move in successively larger circles outward. Lastly, make sure that you palpate the soft tissue in your axilla and in front of your axilla. The lateral “Tail of Spence” is made of breast tissue and is located in this area. When you have completed one side, switch hands, raise the other arm over your head, and examine the breast on that side in the same manner.

There are some tips and tricks to performing a successful breast examination. One major tip for success is to avoid using “piano fingers.” Instead, keep your four fingers together and make them flat so you can feel for differences in the topography of your breast. Also, avoid smashing your breast tissue in between your fingers because this is not a reproducible or approved method for a breast exam. Palpating your tissue towards something relatively immobile and a hard stop such as the chest wall is the best way to feel for any abnormalities. Performing the breast exam in the shower is a good way to allow the soapy water lubricate the skin so that palpations are not as sensitive. Your examining fingers can slide on the skin without as much friction and drag. Some women rather perform the exam laying down in bed so that their raised arm is supported. Lastly, spouses are always very willing volunteers to help with your breast exam. You would be surprised at how many husbands find suspicious lumps on their wife’s breasts!

If you think that you feel something abnormal, contact your primary care physician immediately. They may order some imaging such as a mammogram (X-ray of the breast tissue) or an ultrasound. It is better to seek help than to sit on a potential problem.

There you have it! With some practice, you will be your own self breast exam expert.