Breast Self-Exam (BSE)
Why is BSE important?
Monthly breast self-examination (BSE) is an important part of health care for all women in every stage of life.
This is one physical examination you can do yourself, in the privacy of your own home.
Women can discover breast changes themselves through self-exams, so this is an important health routine to establish.
In addition to BSE, women should get regular breast examination by their health care provider. Women should have annual mammograms starting at age 40.
Doing these steps have been shown to improve the chances of early detection of breast cancer.
Step by step
First, it is important that you learn the normal characteristics of your breast tissue. No two women are the same. What is normal for another woman may not be normal for you.
It is a good idea to have your health care provider show you the proper procedure for BSE. At the same time, they can explain what you are feeling in the breast tissue, so you will be able to notice changes from month to month when you perform BSE on your own.
Set aside a scheduled time each month for BSE. If you are still menstruating, the best time for BSE is 2 to 3 days after your period ends, when your breasts are less likely to be tender and swollen.
If you have gone through menopause, whether naturally or surgically, pick a specific day of the month for this routine. It is very important that you make BSE a lifetime habit.
Stand in front of a mirror with your upper body unclothed, and press both hands behind your head.
Look for changes in the shape, color and size of your breasts. Check for dimples of the skin or “pulling in” of the nipples. Check for scaling or a rash on your nipples.
Next, place your hands on your hips and tighten the chest muscles by pressing firmly inward while looking for any change from your breasts’ usual appearance. Perform this step while leaning slightly forward, then again while standing upright.
You may use 1 of 3 different methods — the circular method, the “wheel spokes” method, or the grid method.
During breast self-exam, be sure to use the fat pads of the fingertips of the 3 middle fingers.
- Circular method
Use the hand opposite the breast you are examining. Beginning at the outermost top of your breast, press the flat portions of the 2nd, 3rd, and 4th fingertips into your breast. Moving in small circles slowly around your breast, work toward the nipple. Press firmly to feel deep tissues and gently to feel tissues under the skin. Be sure to cover the entire breast without skipping any areas. Repeat for your opposite breast.
- “Wheel spokes” method
Imagine that your breast is divided into pie-shaped sections, much like spokes divide a wheel. Begin at the outermost top of the breast. Press the flat portions of the fingertips into your left breast, moving first toward the nipple, then away from the nipple. When you complete that section, slide your fingers slightly to the next area and repeat the process gradually moving around your entire breast. Repeat for your opposite breast.
- Grid method
Begin at the innermost portion of the breast, near the breastbone. With the flat portions of the fingertips, move down your breast pressing firmly and gently. Slide your fingers slightly and move up your breast, then down, and so forth, until the entire breast area has been examined. Repeat for the opposite breast.
It is important that you choose the method that’s most comfortable for you, and use the same method each month.
Whichever method you use, do not skip any areas of the breast. Check for lumps, thickening, or any change from the previous examination.
To examine your left breast, using one of the 3 methods mentioned, lie flat on your back with a small pillow or a folded towel under your left shoulder. Raise your left arm over your head.
Use the flat portions of the 2nd, 3rd, and 4th fingertips of your right hand to examine the left breast.
Press firmly to feel deep tissues and more gently to feel tissues under the skin.
Repeat the entire procedure for the right breast.
In addition, be sure to check the area between the upper outer breast and your armpit as well as the armpit itself. Check the area just above your collarbone for enlarged lymph nodes.
Pay special attention to the area between the breast and your armpit, including the armpit itself. Check the area just above your collarbone for enlarged lymph nodes.
In the shower
The next part of breast self-examination is performed in the shower, where the soapy, wet surface of the skin can make it easy to feel lumps.
Breast self-examination in the shower is important because masses in the upper part of the breast are easier to detect while standing upright; masses in the lower part may be felt more easily while lying down.
Place your left hand behind your head and, with the flat portions of the 2nd, 3rd, and 4th fingertips of the right hand, examine your entire left breast using 1 of the methods described. Repeat for your right breast.
Changes in the breast
It is important that you see your health care provider if you detect a lump or change in the breast, such as nipple discharge, change in texture, dimpling of the skin, or “pulling in” of the nipple.
Eighty percent of all lumps found are normal tissue, benign (non-cancerous) cysts, or benign masses. Only your health care provider can determine the reason for the change.
If you notice a change in your breast tissue, don’t wait. See your health care provider right away — even if you have had a negative mammogram in the past.