Susan L. Grant MD and Margaret Klugman
Obstetics and Gynecology Board Certified
8 East 83rd Street
New York, New York 10028
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A breast examination by a health professional (such as your doctor, nurse, nurse practitioner or physician assistant) is an important part of routine physical checkups.
How Often Should I Have a Clinical Breast Exam?
You should have a clinical exam at least every three years starting at age 20 and every year with annual exam starting at age 40. A clinical breast exam may be recommended more frequently if you have a strong family history of breast cancer.
When Should I Schedule a Clinical Breast Exam?
Breast exams are best performed soon after your menstrual period ends, because your breasts will not be as tender and swollen as during your period. This makes it easier to detect any unusual changes. If you have stopped menstruating, schedule the yearly exam on a day that's easy for you to remember, such as your birth date.
What Happens During a Breast Physical Exam?
Your healthcare provider will ask you detailed questions about your health history, including your menstrual and pregnancy history. Questions might include what age you started menstruating, if you have children and how old you were when your first child was born.
A thorough breast exam will be performed. For the exam, you undress from the waist up. Your healthcare provider will look at your breasts for changes in size or shape. Your provider may ask you to lift your arms over your head, put your hands on your hips or lean forward. He or she will examine your breasts for any skin changes including rashes, dimpling or redness. This is a good time to learn how to do a breast self-exam if you don't already know how.
As you lay on your back with your arms behind your head, your healthcare provider will examine your breasts with the pads of the fingers to detect lumps or other changes. The area under both arms will also be examined.
Your healthcare provider will gently press around your nipple to check for any discharge. If there is discharge, a sample may be collected for examination under a microscope.
Complete Breast Cancer Screening
Clinical and breast self-examination are important methods of early breast cancer detection and should be performed along with mammography. All three of these methods provide complete breast cancer screening.
The most effective way to fight breast cancer is to detect it early. A breast self-exam may help, although the most effective tools to detect breast cancer are mammography and clinical breast exam by your health professional. In fact, women who perform regular breast self-exams find 90% of all breast masses.
What Is a Breast Self-Exam and Why Should I Do It?
The breast self-exam is a way that you can check your breasts for changes (such as lumps or thickenings) that may signal breast cancer. When breast cancer is detected in its early stages, your chances for surviving the disease are greatly improved. While 80% of all breast lumps are not cancerous, you can help catch potentially serious changes in the breast early by regularly performing a self-exam.
When Should I Perform a Breast Self-Exam?
It is good to start performing breast self exams in your 20's. You should examine your breasts once a month, three to five days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month, such as the first day of the month or a day easy for you to remember, such as your birth date. With each exam, you will become familiar with the contours and feel of your breasts, and will be more alert to changes.
How Do I Perform a Breast Self-Exam?
To perform a breast self-exam, follow the steps described below.
In the mirror:
|1. ||Stand undressed from the waist up in front of a large mirror in a well-lit room. Look at your breasts. Don't be alarmed if they do not look equal in size or shape. Most women's breasts aren't. With your arms relaxed by your sides, look for any changes in size, shape or position, or any changes to the skin of the breasts. Look for any skin puckering, dimpling, sores or discoloration. Inspect your nipples and look for any sores, peeling or change in the direction of the nipples.|
|2. ||Next, place your hands on your hips and press down firmly to tighten the chest muscles beneath your breasts. Turn from side to side so you can inspect the outer part of your breasts.|
|3. ||Then bend forward toward the mirror. Roll your shoulders and elbows forward to tighten your chest muscles. Your breasts will fall forward. Look for any changes in the shape or contour of your breasts.|
|4. ||Now, clasp your hands behind your head and press your hands forward. Again, turn from side to side to inspect your breasts' outer portions. Remember to inspect the border underneath your breasts. You may need to lift your breasts with your hand to see this area.|
|5. ||Check your nipples for discharge (fluid). Place your thumb and forefinger on the tissue surrounding the nipple and pull outward toward the end of the nipple. Look for any discharge. Repeat on your other breast.|
In the shower:
|6. ||Now, it's time to feel for changes in the breast. It is helpful to have your hands slippery with soap and water. Check for any lumps or thickening in your underarm area. Place your left hand on your hip and reach with your right hand to feel in the left armpit. Repeat on the other side.|
|7. ||Check both sides for lumps or thickenings above and below your collarbone.|
|8. ||With hands soapy, raise one arm behind your head to spread out the breast tissue. Use the flat part of your fingers from the other hand to press gently into the breast. Follow an up-and-down pattern along the breast, moving from bra line to collarbone. Continue the pattern until you have covered the entire breast. Repeat on the other side.|
|9. ||Next, lie down and place a small pillow or folded towel under your right shoulder. Put your right hand behind your head. Place your left hand on the upper portion of your right breast with fingers together and flat. Body lotion may help to make this part of the exam easier.|
|10. ||Think of your breast as a face on a clock. Start at 12 o'clock and move toward 1 o'clock in small circular motions. Continue around the entire circle until you reach 12 o'clock again. Keep your fingers flat and in constant contact with your breast. When the circle is complete, move in one inch toward the nipple and complete another circle around the clock. Continue in this pattern until you've felt the entire breast. Make sure to feel the upper outer areas that extend into your armpit.|
|11. ||Place your fingers flat and directly on top of your nipple. Feel beneath the nipple for any changes. Gently press your nipple inward. It should move easily.|
Repeat steps 9, 10 and 11 on your other breast.
Interestingly, cancerous tumors are more likely to be found in certain parts of the breast over others. If you divide the breast into 4 sections, the approximate percentage of breast cancers found in each area are (in clockwise pattern):
- 41% upper, outer quadrant
- 14% upper, inner quadrant
- 5% lower, inner quadrant
- 6% lower, outer quadrant
- 34% in the area behind the nipple
Almost half occur in the upper outer quadrant of the breast, towards the armpit. Some physicians refer to this region as the "tail" of the breast and encourage women to examine it closely.
What Should I Do If I Find a Lump?
See your healthcare provider if you discover any new breast changes, changes that persist after your menstrual cycle, or other changes that you are concerned about. Conditions that should be checked by a doctor include:
- An area that is distinctly different from any other area on either breast.
- A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
- A change in the size, shape or contour of the breast.
- A mass or lump, which may feel as small as a pea.
- A marble-like area under the skin.
- A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly or inflamed).
- Bloody or clear fluid discharge from the nipples.
- Redness of the skin on the breast or nipple