A woman standing in front of a bathroom mirror and looking at her reflection.
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Up until recently, performing a breast self-exam (BSE) had been recommended in helping to detect early signs of breast cancer in women throughout the United States. Today, the BSE is not as highly regarded by many cancer authorities and organizations as a screening tool for breast cancer—studies have shown that it doesn’t offer the early detection and survival benefits of other screening tools.

“Multiple studies have demonstrated that BSE done routinely offered no advantage in breast cancer survival and had more false positive results, resulting in twice as many biopsies with negative results,” explains Dr. Wilfred Brown, a double board certified plastic surgeon at the Laser & Skin Surgery Center of New York. “Although BSE is not recommended as a screening tool, a woman should be familiar with the way her breasts look and feel, as this may help a woman notice changes in her breasts that may warrant additional testing.”

How often should a breast self exam be performed?

Ideally, a woman will perform the BSE once a month, at the same time of the month. “If she is menstruating, her breasts may change throughout her cycle and thus it is important to pick the same time of the cycle for consistency, and again, the ideal time would be immediately after her period has stopped,” says Shieva Ghofrany, MD, a partner at Coastal Obstetrics & Gynecology in Stamford, CT. “In women on the pill, using the ring or the patch, I remind them that the first day of their new pack each month coincides with the end of their bleeding, and is a good way to remember to check—i.e. the day you open your pill/patch/ring pack, remind yourself to check your breasts.”

In non-menstruating women (either post menopausal or on continuous hormone contraception and skipping their period), it is easiest to pick the first of the month or some other monthly hallmark as a reminder.

How do you perform a breast self-exam?

The official BSE is a three-part system, and any changes in the appearance or feel of the breast should be noted and reported to your health care provider. “Exams should be performed in the shower using the middle fingers placed flatly on the breast and armpit areas,” explains Brown. “Gentle pressure should be applied initially followed by firm pressure—one should feel for new areas of thickening or lumps.”

The second part of the exam includes standing in front of a mirror to look for any changes in contour of the breast itself or the nipple areolar complex. “When in front of the mirror, look for changes in the skin like puckering, dimples or asymmetry that may be new,” says Ghofrany. “Be sure your nipples are not suddenly inverted, look straight ahead in the mirror with your arms down and then raise them above your head to see if the contours/symmetry has changed.”

Finally, an exam should be performed while lying flat on the back, with the hand placed behind the head. “Gentle then firm pressure should be used to feel the breast and armpit areas with the opposite hand, and the nipple should be checked for any drainage,” says Brown. “All exams should be performed in a systematic way covering the whole breast and armpit area—up and down motions as well as circular motions should be used as one covers the whole breast.”

So, what’s considered normal?

According to Brown, normal is different for every woman. “The importance of noticing anything new or changing in the breast is very important—if anything new is identified, additional screening tools such as mammography, ultrasound or MRI may be used to evaluate these changes,” says Brown. “It is important not to panic if one feels a lump and schedule an appointment with your doctor. Eight out every ten lumps felt are not cancerous.”

Although BSE might not be as effective as once thought, it’s important to know what your breasts normally feel, so that, if you do feel something off, you can report it to your doctor for further testing. “I encourage my patients at a young age to start ‘getting to know their breasts,’” says Ghofrany. “The purpose is to remind them that the likelihood of discovering anything onerous at a young age is very slim, but that it’s a good time to establish a monthly habit and to feel comfortable knowing what they feel like in general so that if/when something feels ‘different,’ they know to call their doctor.”