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The American
Cancer Society recommends beginning in their 20s, women should be told about
the benefits and limitations of BSE. Women should be aware of how their
breasts normally look and feel and should report any breast changes to a
health professional as soon as they are found. Finding a breast change does
not mean there is a cancer.
Women
can notice changes by being aware of how their breasts normally look and feel
and by feeling their breasts for changes (breast awareness) or by choosing to
use a step-by-step approach, using a specific schedule to examine her breasts
(breast-self exam, or BSE)
If
you choose to do BSE, the following information provides a step-by-step
approach for the exam. The best time for a woman to examine her breasts is
when the breasts are not tender or swollen. Women who are pregnant,
breast-feeding, or have breast implants can also choose to examine their
breasts regularly. Women who examine their breasts should have their
technique reviewed by their health care professional during their clinical
breast exams (CBE). It is acceptable for women to choose not to do BSE or to
do BSE occasionally. Women
who choose not to do BSE should still be aware of their breasts and report
any changes to their health care professional without delay.
How to Examine Your Breasts
Lie down and place your right arm behind
your head. The exam is done while lying down, and not standing up. This is
because when lying down the breast tissue spreads evenly over the chest wall
and it is as thin as possible, making it much easier to feel all the breast
tissue.
Use the finger pads of the three middle
fingers on your left hand to feel for lumps in the right breast. Use
overlapping dime-sized circular motions of the finger pads to feel the breast
tissue.
Use three different levels of pressure to
feel all the breast tissue. Light pressure is needed to feel the tissue
closest to the skin; medium pressure to feel a little deeper; and firm
pressure to feel the tissue closest to the chest and ribs. A firm ridge in
the lower curve of each breast is normal. If you’re not sure how hard
to press, talk with your doctor or nurse. Use each pressure level to
 feel
the breast tissue before moving on to the next spot.
Move around the breast in an up and down
pattern starting at an imaginary line drawn straight down your side from the
underarm and moving across the breast to the middle of the chest
bone (sternum or breastbone). Be sure to check the entire breast area going
down until you feel only ribs and up to the neck or collar bone (clavicle).
There is some evidence to suggest that
the up and down pattern (sometimes called the vertical pattern) is the most
effective pattern for covering the entire breast without missing any breast
tissue.
Repeat the exam on your left breast,
using the finger pads of the right hand.
While standing in front of a mirror with
your hands pressing firmly down on your hips, look at your breasts for any
changes of size, shape, contour, dimpling, pulling, or redness
or scaliness of the nipple or breast skin. (The pressing down on the hips
position contracts the chest wall muscles and enhances any breast changes.)
Continue to look for changes with your arms down at your sides and then with
your arms raised up over your head with your palms pressed together.
Examine each underarm while sitting up or
standing and with your arm only slightly raised so you can easily feel in
this area. Raising your arm straight up tightens the tissue in this area and
makes it difficult to examine.
This
procedure for doing breast self-exam is different than previous procedure
recommendations. These changes represent an extensive review of the medical
literature and input from an expert advisory group. There is evidence that
the woman's position (lying down), area felt, pattern of coverage of the
breast, and use of different amounts of pressure increase the sensitivity of
BSE as measured with silicone models, and for CBE using patient models with
known small non-cancerous lumps in their breasts.
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