How to Perform Breast Self-Examination (BSE)
What is BSE?
Breast self-examination is a procedure performed by an individual to physically
and visually examine herself for any changes in the breasts and underarm areas
of the body. A BSE alone cannot accurately determine the presence of breast
cancer. So, BSE should not be used in place of, but in addition to, clinical
breast examination and mammography.
When should BSE be done?
Women should begin practicing breast self-examination by age 20 and continue the practice throughout their lives -- even during pregnancy and after menopause.
Breast self-examination should be performed every month. Become familiar with how your breasts usually look and feel so that you may detect any change from what is normal for you.
- If you still menstruate, the best time to do BSE is one week after your
period starts. These are the days when your breasts are least likely to be
tender or swollen.
- If you no longer menstruate, pick a certain day -- such as the first day of each month -- to remind yourself to do BSE.
- If you are taking hormones, talk with your physician about when to do BSE.
Changes to be aware of:
Check with your physician if you find any change in your breast(s) that causes you concern. Changes in your breasts may include:
- development of a lump or swelling
- skin irritation or dimpling
- nipple pain or retraction (turning inward)
- redness or scaliness of the nipple or breast skin
- a discharge other than breast milk
Monthly breast self-exams should always include: visual inspection (with and without a mirror) to note any changes in contour or texture; and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.
How to do BSE:
- Stand in front of a mirror that is large enough for you to see your breasts
clearly. Check each breast for anything unusual. Check the skin for puckering,
dimpling, or scaliness. Look for a discharge from the nipples.
Do steps 2 and 3 to check for any change in the shape or contour of your breasts.
As you do these steps, you should feel your chest muscles tighten.
- Watching closely in the mirror, clasp your hands behind your head and press
your hands forward.
- Next, press your hands firmly on your hips and bend slightly toward the
mirror as you pull your shoulders and elbows forward.
- Raise one arm. Use the pads of the fingers of your other hand to check the
breast and the surrounding area firmly, carefully, and thoroughly. Some women
like to use lotion or powder to help their fingers glide easily over the skin.
Feel for any unusual lump or mass under the skin. Feel the tissue by pressing
your fingers in small, overlapping areas about the size of a dime. To be sure
you cover your whole breast, take your time and follow a definite pattern:
lines, circles, or wedges.
Some research suggests that many women do BSE more thoroughly when they use
a pattern of up-and-down lines or strips. Other women feel more comfortable
with another pattern. The important thing is to cover the whole breast and
to pay special attention to the area between the breast and the underarm,
including the underarm itself. Check the area above the breast, up to the
collarbone and all the way over to your shoulder.
Lines: Start in the underarm area and move your fingers downward
little by little until they are below the breast. Then move your fingers
slightly toward the middle and slowly move back up. Go up and down until
you cover the whole area.
Circles: Beginning at the outer edge of your breast, move your
fingers slowly around the whole breast in a circle. Move around the breast
in smaller and smaller circles, gradually working toward the nipple. Don't
forget to check the underarm and upper chest areas, too.
Wedges: Starting at the outer edge of the breast, move your fingers
toward the nipple and back to the edge. Check your whole breast, covering
one small wedge-shaped section at a time. Be sure to check the underarm
area and the upper chest.
It is important to repeat step 4 while you are lying down. Lie flat on
your back, with one arm over your head and a pillow or folded towel under
the opposite shoulder. This position flattens the breast and makes it easier
to check. Check each breast and the area around it very carefully using
one of the patterns described above.
Some women repeat step 4 in the shower. Your fingers will glide easily
over soapy skin, so you can concentrate on feeling for changes underneath.
However, the shower method should be used in addition to, not instead
of, the lying down method.
If you notice a lump, discharge, or any other change during the month --
whether or not it is during BSE -- contact your physician as soon as possible.