Are Self-Breast Exams Necessary? What Women Need to Know
Evidence is growing that monthly self-tests don’t reduce deaths from breast cancer, but you shouldn’t ignore your breasts, either. These key insights could clear up the confusion—and potentially save your life.
Your breasts are naturally lumpy and bumpy
The breast is a lumpy organ, says Seema Khan, MD, professor of surgery at Northwestern University’s Feinberg School of Medicine in Chicago. It’s helpful to know this, as women performing monthly self-exams can endure unnecessary anxiety, testing, and biopsies after detecting something that turns out to be a completely normal lump or bump. Get to know the architecture of your breasts, including which parts tend to be lumpier than others, so you can identify any changes if they occur. Be on the lookout for changes in the size or shape of the breast, discharge, and any itching, swelling, thickening, dimpling or other differences in the skin. (Related: These are breast cancer symptoms you shouldn't ignore.)
Your breasts change around your period
Your menstrual cycle plays a large role in the texture of your breasts—they feel lumpiest and most tender right before your period due to a rise in estrogen and progesterone levels. “If the breast feels different right before a period, let the period happen before you check again and then decide if you need to see a doctor or not,” Dr. Khan says. The best time to check your breasts is right after your period when the tenderness dissipates and the lumpiness should return to your natural baseline. If it doesn’t, it might be time to set up a doctor’s appointment. Here are a few other things that happen during your period.
You can help prevent breast cancer
Modifiable risk factors for breast cancer include diet, physical exercise, maintaining a close-to-ideal body weight, and consuming alcohol in moderation. “We recommend a standard healthy diet rich in fruits and vegetables and whole grains, and low in animal fats and proteins,” says Dr. Khan. She also recommends boning up on calcium from a variety of sources including dairy and greens. When it comes to alcohol, the risk goes up a little bit with every drink beyond three or four per week, though it’s probably okay to have one alcoholic beverage a day, according to Dr. Khan.
You should know your personal breast cancer risk
All women should practice breast self-awareness, which is basically knowing the architecture of your breasts and being aware of changes. However, it’s also important to know whether you’re technically at higher risk of developing breast cancer, because if so, you may need different types of screening or more frequent screening. Risk factors include a family history of breast cancer, advancing age, obesity (especially in postmenopausal women), and the use of hormones, especially the combination of estrogen and progesterone, according to Therese Bevers, MD, medical director of clinical cancer prevention at MD Anderson Cancer Center in Houston. Women with high-risk breast lesions found on a breast biopsy are also at high risk. “For higher-risk patients, we actually do different types of screening than for average-risk patients,” Dr. Bevers says. “I may see you every six months instead of once a year, and do a breast exam and imaging every six months, alternating between mammogram and MRI.”
You’re more likely to notice irregularities on the fly
In 2013, the United States Preventive Services Task Force recommended against teaching women how to perform breast self-exams—because that’s not when most abnormalities are found. “The vast majority of breast cancers are found by women not during breast exams, but during activities of daily living—showering, dressing, scratching, applying lotion, things like that,” Dr. Bevers says. “That’s why the focus has shifted to breast awareness.” Read up on the secrets your breasts won’t tell you, but that you should definitely know.
If you do feel something abnormal, take action
Don’t wait until your annual screening. “If you feel something and it doesn’t go away after your next period, make sure you come in and get diagnostic imaging, usually a mammogram and ultrasound,” says Heidi Memmel, MD, director of breast surgery at Advocate Lutheran General Hospital in Park Ridge, Illinois. Mammograms are great screening tools, but they don’t work as well for dense breast tissue, which is very common, according to Dr. Memmel. Dense breast tissue shows up white on mammograms, as does cancer, making tumors more challenging to spot. Detection is easier with ultrasound, which is better for diagnosis and pinpointing the exact area of concern. If you feel something suspicious, ask for a diagnostic mammogram, ultrasound, or MRI. But don't freak out if you're just feeling soreness—these are surprising causes of breast soreness.
Usually a lump is nothing
Rest assured: If you do find an abnormality, it will probably be benign. During diagnostic evaluation of abnormal findings, including abnormal mammograms, the experts typically find cancer in only 10 to 20 percent of patients, according to Dr. Bevers. It’s still a good idea to be evaluated, though, just to be safe. Don’t fall for these breast cancer myths.
- Heidi Memmel, MD, director of breast surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois
- Seema Khan, MD, professor of surgery, Northwestern University’s Feinberg School of Medicine, Chicago
- Therese Bevers, MD, medical director, clinical cancer prevention, M.D. Anderson Cancer Center, Houston
- United States Preventive Services Task Force: "Breast Cancer: Screening"