It certainly sounds like a no-brainer--if you want a free, effective way to screen for breast cancer, teach women to examine their breasts. After all, up to 70% of breast cancers are found by women checking their own breasts. Unfortunately, it turns out that Breast Self-Examination (BSE) isn't as effective as people had hoped. In fact, studies have found that it does not reduce breast cancer deaths. Also, it isn't really free because of the cost in materials and time to teach women to examine their breasts.
So if you are like me and have felt guilty because you skip checking your breasts more often than not, you can drop that guilt. What more and more health care organizations are advocating is breast awareness. You don't need to set a day each month to formally examine your breasts, but you do need to know what is normal for you and be alert for changes.
Whether you are a person who wants a structured, regular way to check your breasts, or one whose anxiety about BSE makes informal assessment more appropriate, it is important to know what to look for. Before I was diagnosed with inflammatory breast cancer, I thought I was looking for lumps when I examined my breasts. In fact, after my diagnosis, I was angry that no one told me I should be alert for visible changes . I even went back to the brochure I had received at my doctor's office to prove that I had been led astray. There in the last sentence was the advice to also look for dimpling and changes in color--clues that could have given me a greater sense of urgency about checking out my early symptoms of IBC. Somehow the emphasis in BSE on finding that dangerous, cancerous lump had led me to overlook vital information.
If you decide that you want to formally examine your breasts, here are some some guidelines from the American Cancer Society about the most effective method.
- The best time to check is when your breasts are not swollen, so right after your period is good for most premenopausal women. Lying down with one arm behind your head is the best position because it flattens out the breast tissue.
- Using your three middle fingers, make small circles on your breast with increasing firmness. A light touch will allow you to find changes near the skin; medium and firm pressure can detect changes deeper in the breast tissue.
- Current recommendations suggest that following an up and down pattern is more effective than a circular or wedge pattern. Start at the armpit, going down your side; then move in a little and go back up as high as the collar bone. Keep going up and down from the collarbone to the bottom of your rib cage until you get to the center of your chest. Then switch arms and check your other breast. You are looking for changes in your breast tissue--a lump or a thickened area. Some women have very lumpy breasts all the time; that is their normal and is nothing to worry about.
- Look for visual changes in the mirror. Put your hands on your hips and notice if the color or shape of your breasts has changed. Is one breast larger than usual? Are there any dimples? A dimple could be an indentation caused by a lump changing the contour of your breast. Another kind of dimpling is called "orange peel" because the surface of the skin looks like the skin of an orange. Is there any scaliness or other change in the texture of your skin? Look on the underside of your breasts and raise your arms slightly to check your underarms. Some forms of cancer do not have a lump, and sometimes a lump that can't be felt can still cause visual changes, so don't skip this part of BSE. Even if you don't do BSE regularly, pay attention in the mirror when you step out of the shower.
The up-and-down pattern (above) is believed by many experts to be the most effective. Examination should be performed while lying down, not standing up.
If you are in your teens, there is no need to start BSE. The point of regular breast checks is to look for changes, and teens' breasts are changing all the time. Women in their twenties and older should talk to their doctors about their personal risk for breast cancer and decide if BSE is right for them.
Over the course of a woman's life time, she will probably find a lump or a breast change. Most of the time, the change will not be cancer or even a dangerous benign condition. One of the reasons some people oppose regular BSE is because of the anxiety and expense involved in checking out non-cancerous changes. As a survivor of a rare form of breast cancer, I confess that I find this reasoning disturbing. Sure, it is expensive to the individual patient and society to check out breast changes, and it certainly provokes anxiety, but there is no way to know if a change is dangerous unless a doctor actually does an examination which may include diagnostic imaging tests, and maybe even a biopsy.
So if you find a lump or notice a rash, don't panic. The chances are high that the problem is not serious. Be proactive about your health and have the situation checked out, especially if it lasts longer than a month. However, try not to worry.
Allen, T. et al. The Breast Self-Examination Controversy: What Providers and Patients should Know. Journal for Nurse Practitioners. Retrieved from http://www.medscape.com/viewarticle/725641_1 March 19, 2014.
Breast Awareness and Self-exam. American Cancer Society. Revised Jan. 28, 2014. Retrieved from http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs-bse March 19, 2014.