Self-breast examination - How, when & why?

Breast cancer is the most common cancer among women and the incidence has been steadily rising over the years.

According to research, approximately 12-13% of women will be diagnosed as having breast cancer at some point in their lifetime. The incidence is higher among women of urban background as compared to the rural women and is higher among Indians & Asians as compared to their western counterparts.

There are multiple factors which increase your risk of developing breast cancer –female gender and age > 40 years are the biggest risk factors. 

Although it is not always possible to avoid developing breast cancer, still being vigilant & carrying out a regular, monthly self-breast examination is the first step towards early detection & treatment of breast cancer. 

Breast self-examination (BSE) means examining your breasts by yourself and it acts as an aid in the early diagnosis. 

Being aware of the normal structure and feel of the breast helps to identify if there is any abnormality. BSE is the easiest and most cost-effective way of screening which can be done within the privacy of your room. 

Once you learn the correct technique you are good to go. 

Why do a BSE?

Early detection increases the survival rate for breast cancer. 

When coupled with regular screening like mammogram & ultrasound, BSE helps to detect abnormal breast lumps early so that breast cancers can be detected early and appropriate treatment can be given. 

Remember to never substitute your regular mammograms with BSE. 

What is the best time for BSE?

• Every girl in her 20’s should begin with BSE, once a month every month.
• For menstruating woman, it is best to perform BSE a week after your periods as breasts tend to be sore and lumpy during your periods due to hormonal fluctuations. 
• For those who are post-menopausal choose a particular day or date that is easy to remember and conduct your BSE on that particular chosen time. It will help you to be consistent.
• Women above 40 years of age should also perform an annual mammogram.
• It takes a few minutes to examine your breasts and can be easily incorporated into your daily schedule. 
• You can perform the BSE while in the shower, before dressing up, before you sleep or after you wake up while lying in your bed. 

What should I be looking for? 

• Any change in size and shape of the breasts
• Signs of redness, dimpling, puckering or scaling of the breast skin or nipples 
• Accentuated veins over the surface of the breast
• Unusual swelling of upper arm or in the armpit 
• Unusual discharge from the nipples 
• Puckered or inverted nipples
• Any visible or palpable swelling over the skin or in the breast tissue

How should I perform the BSE?

Step 1: Visual examination 

• Begin by undressing and standing before a large mirror in a well-lit room. And relax. 
• Keep your arms by your side and notice the normal shape & size of your breasts. Look for changes of shape, size or any other signs mentioned above. 
• Raise your hands over your head and look for any abnormality in shape, size or skin. 
• Lift your breasts to see if the ridges at the bottom are identical & normal.
• Next, keep your hand on your hips and flex your chest and look for the same changes. 

Step 2: Using your hands

• Use your right hand to inspect your left breast and vice versa.
• Use the pad of your first three fingers to check for any lumps or thick spots in the breast tissue or the skin.
• Use three different kinds of pressure as you feel your breast tissues.  By applying light pressure, you can feel the tissues in close proximity with your skin and with a medium pressure you can feel deeper tissues. Finally with firm pressure you can feel the tissue close to the ribs and chest. 
• Use a particular pattern to cover the whole area of the breast. 

You can follow a circular pattern and begin at the nipples and move outside till your collar bone & armpits or you can move in rows from the top to bottom ie from the collar bone to the lowermost edge of breast tissue , like you would be mowing a grass lawn. 

• Cover the entire area from top to bottom and side to side. Starting from your collarbone to the top of your abdomen and from your cleavage to the armpit as the breast tissues extend to the armpit. 
• Squeeze your nipples gently and look for any discharge, or to see if your nipples turn inward. 
• Remember to check both the breasts. 

Step 3: While lying down 

When you lie down, the breast tissue spreads evenly which makes it easier to detect any abnormal signs.

Keep a pillow below your right shoulder and use your left hand while examining your right breast. Keep your right hand behind your head. 

• Use the same technique mentioned above to feel your breast tissue and nipple from top to bottom or from the centre towards outside. 
• Swap the pillow under left shoulder and use your right hand to examine your left breast. Likewise keep your left hand behind your head while examining your left breast. 

It will take a few months to master the technique. Some women find it easier to examine the breast while the skin is wet and slippery and do it while in the shower. Make this a routine and you will know how your breast looks & feels normally.  You can also maintain a diary to note down the irregularities you notice and the time of the month when these are noticed. 

It can help to rule out the causative factors and in making a correct diagnosis. 

What if I detect a lump? 

Firstly, do not panic if you detect a breast lump.

Breathe! 

Most of the times, these lumps are harmless and are not cancerous. There are other reasons for lumps to form in your breast. If, however, the lump grows bigger and lasts an entire month, visit your doctor who will help you understand the situation & make a correct diagnosis. 

According to some experts, the effectiveness of BSE is a debated topic and many experts do not recommend BSE owing to the fact that detection of a lump instils a sense of fear of having cancer in women and leads to unnecessary tests & biopsies that can further increase the cost of healthcare.  

However, although BSE has its drawbacks of some over investigation, it surely does give you a heads up regarding any irregularity and helps in early diagnosis.

In conclusion, it is good to know your breasts well and be aware of the changes. Being proactive and taking preventive steps will help to reduce the mortality due to the cancer. BSE is an easy tool and you don’t need any specific expertise to perform this. Practice will make you perfect and as it is said “an ounce of prevention is worth a pound of cure.

For more information on Breast Health, please check our other videos.