How to do a breast self-exam at home

In the Netherlands and in the UK, 1 in 7 women develop breast cancer (1). A shocking statistic - so we recommend doing a breast exam regularly. It’s part of becoming comfortable with yourself and with your body; a way of knowing what’s going on on the inside. Compare it to skincare: you can feel irregularities coming because you’re used to massaging your face. In a similar manner, getting to know how your body feels and should feel makes it easier to notice changes.


Even though periodic breast check ups for healthy individuals without symptoms are generally not recommended in the current guidelines (research has shown that it can be overmedicalizing) (3), we do think it's good for women to know what to look out for, especially if they have a family history of breast/ovarian cancer.


Check your risk factors

Next to doing a self-exam, it’s very important to know whether breast cancer occurs in the family. When asking, keep in mind that you need to check both the maternal and the paternal side of the family, and check for both breast and ovarian cancer (as the two are linked).


Other risk factors besides family history are:

  • Age (risk increases with age)

  • Early first period

  • Late menopause

  • Not having children, or having children later in life (having children after 30 doubles the risk compared to women who had their first kid at 20)

  • Mild increased risk if not breastfeeding

  • Possibly: long-term oral contraceptive use (>10 years), alcohol (especially 4+ drinks a day), and an inactive lifestyle


The self-check: when and where?

Checking irregularities only takes a few minutes, and you can do the first two steps while you're in the shower. The best time to do a monthly self-breast exam is about 3 to 5 days after your period starts. It’s important to do it at the same time in your cycle, as your breasts are not as tender or lumpy at this time in your monthly cycle.


Breast self-exam: The 3 steps

This instruction is mainly focused on women before menopause. After menopause there are some other things to look out for; besides this, all menopausal women (or women over the age of 50) in the UK and the Netherlands are invited for breast screening every 2 or 3 years (2).


1. Looking

Take off your shirt and bra, and stand in front of a mirror. Look at yourself while doing the following poses: putting your arms alongside your sides, raising both arms high overhead, and putting your hands on your hips and pressing firmly (flexing chest muscles). Be sure to take a look at both breasts. In each position check for:

  • Any changes in breast size or shape.

  • A noticeable swelling in the breast, or under the armpits.

  • Dimpling of the skin or nipple(s). This can express itself as one large dimple, or as little dimples in the skin which may look like cellulite. The official medical term is 'Peau D’Orange' (French for orange peel), which makes sense as the texture is similar.

  • Changes in the nipples (e.g. flaking or eczema of the nipple and areola, or retraction of the nipple).

  • Unusual discharge from the nipple (bloody or brown colored).

  • Any little sore that doesn’t heal properly.

  • Inflammation of the breast (tender, painful, swollen, red). This may be a sign of a normal infection of breast tissue as well.



2. Feeling

Use your right hand to examine your left breast, and vice versa. Press on every part of your breast with the pads of your three middle fingers and make little circular movements, starting from the area around the nipple and working outward while increasing pressure slowly. Feel for any lumps, thick spots or other changes. Don't forget to check the tissue in your armpits and under the areolas.

A few characteristics of breast lumps which are important to look out for:

  • Lumps that feel irregular. This means it might be difficult to determine where the lump starts and ends. Benign lumps such as cysts are usually more smooth, similar to the surface of a marble.

  • Lump that feel rock-hard are usually a bad sign. Softer lump may indicate a cyst or fibroid.

  • Lumps that seem to be attached to the skin or bottom layer of the breast, meaning you can’t manipulate them with your hands.

  • Localised pain of the breast at the site of the lump. However, the chances of a malignancy when there is only localised pain, without any other symptoms or a lump, is very small (0-3%) (3).




3. Lying down

When you're lying down, your breast tissue spreads more evenly, so this is a good position to check for changes - especially if your breasts are large. Place your right arm behind your head, and use your left hand to repeat the movements of the previous step.

What should I do if I find something?

First of all - don't panic. Most self exam findings are not a sign of breast cancer, and most breast lumps turn our to be benign (for example cysts of fibroids). Be sure to call your GP if you notice a lump or any other breast changes. You can check whether the lump seems to come and go (as it might be related to hormonal changes), but it’s better to do one check up too many. Depending on the physical examination the doctor will recommend an ultrasound and/or mammogram, after which a follow up plan will be made.



References:

  1. https://www.bevolkingsonderzoeknederland.nl/borstkanker/, https://www.breastcanceruk.org.uk/about-breast-cancer/facts-figures-and-q-as/facts-and-figures/

  2. https://www.rivm.nl/en/breast-cancer-screening-programme , https://www.nhs.uk/conditions/breast-screening-mammogram/when-youll-be-invited-and-who-should-go/

  3. https://richtlijnen.nhg.org/standaarden/borstkanker