Women should exam their breasts regularly once a month, 7 to 10 days after the 1st day of her menstrual cycle before ovulation when breasts are not usually tender or swollen. Women who are not menstruating should pick the same day of the month (i.e. first day of the month) to practice self-exam for consistency. The glandular composition of the breast is very sensitive to hormonal changes in the body consistent with the menstrual cycle and consequently a woman's breasts may vary in tenderness from one part of the month to another.
There has been some controversy lately in regards to BSE. You can check out what the BC Cancer agency has to say about the controversy on on their website:
The Canadian Task Force on the Periodic Health Examination has reviewed the practice of BSE as a screening tool for breast cancer. There are no data showing that the practice of BSE results in the lowering of mortality due to breast cancer. The Task Force has therefore concluded that there is insufficient evidence to recommend practicing BSE to detect breast cancer. There are concerns that a large number of unnecessary biopsies and investigations are done for benign lumps and that this is of concern for women.However, regular BSE allows a woman to become familiar with the normal changes within her breasts over time. While most changes are not cancerous, they should be investigated. In conjunction with physician examination, ultrasound and mammogram many changes found on BSE can be diagnosed without an invasive biopsy.
In front of a mirror:
With your arms relaxed and at your sides, inspect your breasts for any changes in size or shape (look for any rashes, puckered or dimpled skin, and for any discharge or change in the nipples). - Turn left and right inspecting side views of the breast (observe for any flattening in side view, inspect bra line areas for moles and skin irritations).
- Raise both your arms over your head and bend forward from your waist inspecting both breasts for any changes.
- Standing straight, raise your arms over your head and move them slowly up and down 3 times observing that the breasts move freely over the chest wall. (Cancer sticks to bone or cartilage so the breasts wouldn't move freely and may cause puckering)
- Turn left and right observing sides of breasts in the same manner.
- Press hands together at chin level and push firmly 3 times to flex your chest muscles observing for unusual findings
- Turn left and right observing sides of breasts and underarm breast tissue in the same manner.
- With arms hanging loosely at your sides take one hand and feel deeply into the armpit (axilla) and check for lumps, bumps or changes that may indicate lymph gland involvement. Repeat on the other side.
Lying down:
- Place the back of your left hand on your forehead (this spreads the breast tissue more evenly on the chest)
- With the fingers of your right hand held together flat, press gently but firmly with small circular motions around an imaginary clock face, feeling the breast tissue between your fingers and your chest wall.
- Begin at the outermost top of your left breast (12 o'clock) and without lifting your fingers, slowly and carefully with small circular motions all the way around the rim of your breast (back to 12 o'clock).
- A ridge of firm tissue in the lower curve of each breast is normal.
- Squeeze the nipple gently to check for unusual discharge
- Move your fingers in toward the nipple about 2cms and feel all the way around again.
- Repeat this action as many times as necessary to be sure you have covered the entire breast, finishing over the nipple.
- Bring your left arm down to your side and still using the flat part of your fingers feel under your armpit since breast tissue is found here as well.
- Repeat the same procedure with the other breast
- This exam can also be done very easily while standing in the shower with soapy hands and doing the exam as described when lying down.
- Remember: it is not so much the technique of breast exam that's important, it's getting used to your own breast so that you could identify a change
Sitting:
- With left hand on right shoulder, raise the left elbow to expose the left armpit.
- With right hand, still using flat of fingers, start at upper edge of breast moving with a circular motion towards the center of the armpit.
- To examine the right breast, repeat the procedure (lying down and sitting) using your left hand.
Your doctor and OPT doctors can do breast exams, demonstrating the technique. Breast exams are often done during your annual pelvic exam or Pap test.
Additional resources
The Breast Self-Exam site has an animated slide show with narration on how and why to do a BSE.
