Breast Self Examination

James Metz, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 1, 2001

An estimated 175,000 women will develop breast cancer in 1999. Clearly those women that are diagnosed with cancer at an early stage of disease have a better chance of cure. Important screening techniques include breast self-examination, breast examinations by trained health care providers, and mammography. Some breast cancers never show up on a mammogram so it is important to perform breast self-examinations.

The American Cancer Society recommends women twenty years of age and older practice monthly breast self-examination.Those children and adolescents that received radiation therapy to the chest region for cancer such as Hodgkin?s Disease should be taught the technique at an even earlier age. The woman should continue performing breast self-examinations for the rest of her life. Breasts should be examined once each month, 7-10 days after the start of the menstrual period. The breast texture andcontour changes in relation to the menstrual cycle. Postmenopausal women should pick the same date each month (i.e. the 1st,mortgage due date, etc.).

There are two major parts to the breast self-examination; visual inspection and palpation. Visual inspection consists of standingin front of a mirror with the breasts uncovered. Observe the contour of each breast. Notice the size of each breast, shape, andnipple position. Make mental notes of each of these parameters and compare for any changes each month. Next, raise armsover your head and note any changes in the skin or dimpling of the skin. Then place your hands on your hips looking fordimpling or skin changes.

Palpation consists of feeling the breasts with the pads of your three longest fingers of one hand. First, while standing, cradle the left breast with the left hand. Gently feel the breast with the three longest fingers on the right hand. Note any lumps or bumps.Note any changes from the last exam. Next, cradle the right breast with the right hand and palpate with the left hand. Againnote any lumps or changes.

After you have palpated the breasts while standing, lie down on your back with the left arm behind the head. Palpate the entirebreast with the three longest fingers on the right hand. There are various techniques that can be used so that all of the breast tissue is palpated:
  1. Start at the areola and go around the breast clockwise in progressively larger circles until the entire breast has been felt.
  2. Divide the breast into equal wedges like a pie and examine each wedge from the nipple out to the edge. Then repeat from the outside to the areola.
  3. Use overlapping vertical or horizontal strips to cover all of the breast tissue.
With each of these techniques, make sure to palpate the area beneath the clavicle (collarbone) and the armpit. Now repeat the procedure on the right breast by placing the right arm behind the head and palpating with the three longest fingers on the lefthand.

Do not hesitate to ask your physician the proper technique for breast self-examination. It may take several times until you feel comfortable with the technique and note the normal texture and consistency of your breast tissue. If you find a lump, feelunusual tenderness or pain, notice changes in the color of the skin, or find secretion from a nipple, notify your physician. Thesesymptoms do not always mean you have cancer. Most abnormal findings are benign. Many other conditions can cause thesechanges. Make an appointment with your health care provider for a formal evaluation. It is important to follow-up on anychanges or unusual symptoms related to your breast self-examination.

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