How to perform a breast self-exam

Current guidance

The American Cancer Society states that routine breast self-exams are now no longer recommended for anyone who is at average risk of breast cancer.

You fall into the average-risk category if you:

• Don’t have a family history of breast cancer
• Don’t have a genetic mutation such as in the BRCA gene
• Haven’t had radiation to your chest before age 30

This change in recommendation didn’t come about because breast exams themselves—whether done by yourself or a provider—cause any harm or should never be done. Rather, they haven’t been proven to provide enough of a benefit to be recommended for the prevention or early detection of breast cancer if you’re at average risk. A review of two large trials by the Cochrane Library showed that the recommendation of performing routine breast exams may also lead to unnecessary biopsies.

What’s a better proven way to screen for breast cancer? Regular mammograms. They are designed to find breast cancer in its early stages, improving the odds for better treatment outcomes. That’s not to say you should never do a breast self-exam. But it’s important to understand that they aren’t as effective as other screening methods like mammograms.

Your breast self-exam checklist

• Pick one day every month to do the self-exam. Picking the same day each month will not only help you be consistent with tracking but will also account for any normal changes your breasts go through during your cycle. If you’re menstruating, your breasts might be sore around your period, so wait a few days after it stops to do a self-exam to avoid discomfort.
• Know the changes you’re looking for. During an exam, you’ll be looking for any visible changes to your breasts and nipples, and if there are any unusual textures to your breast such as dimpling, swelling or puckering. Then you will do an exam where you’ll use the pads of your fingers to feel for any unusual lumps. It should only take you a few minutes to do.
• Check your breasts both while standing up and laying down. Your breast tissue will shift in different positions. Breast exams in both positions can help you become familiar with how your own breasts look and feel and what’s normal for you.

How to do a breast self-exam while standing

1. Take a first look. Stand in front of a mirror without any clothes on above your waist, and with your hands on your hips. Pay attention to how both breasts look—the size, color and how they’re shaped. Do you notice any new changes?
2. Focus on your nipples. You’ll want to make sure there haven’t been any changes in where they are positioned, or if there are new bumps, dimples or an inverted nipple turned inward instead of sticking out. Gently squeeze each of your nipples and check if you see fluid. You’ll want to report any watery or milky fluid, or fluid that is red, yellow or green to your doctor. If you’re breastfeeding, it will be normal to see milk.
3. Move your arms. Raise both hands above your head. Watch to see if both breasts move in the same way and if they’ve changed in shape with the movement. Look for any redness, rash or areas of swelling. Also, pay attention if you notice any soreness or pain when you raise your arms. Check in the area of your lower armpit where your lymph nodes are to see if there’s swelling. Lower your arms down to your sides again.
4. Feel your breasts. Now it’s time to feel your breasts. Raise one arm and place your hand behind your head. With your opposite hand, apply pressure with the pads of your fingers to feel for any changes in the texture of your skin, and for any lumps underneath. Use light, medium and deep pressure to feel all the layers of your breast. Note any dimpling, puckering or areas of swelling. Make sure you’re including under your arms on your ribcage as well as the flat part of your chest wall, as lumps can develop there as well. Repeat with your opposite breast and hand.
   • There are different methods you can use to feel your breasts:
     • Try a circular motion with the pads of your fingers and start at your nipple, moving around and outward. Press, making small circles around your breast, using different pressures. Continue this movement to the outer areas of your breast and over to your underarm.
     • Move your fingers up and down your breast, in rows back and forth.

How to do a breast self-exam while lying down

Once you’ve done a self-exam while standing, you’re not quite done yet. Lay down for the final steps:

• Lay down. Put your head on a pillow and note any changes to the skin on your breasts, or size.
• Feel your breasts. Using the same technique with your arm up and hand behind your head, feel your breasts with your opposite hand, and use the circular or up-and-down method.
• Check the surrounding areas. It's important to feel your underarm area as well as the hard area of your ribcage on your upper chest and sides.

Report any changes in your breasts to your doctor. Of course, it’s hard not to worry when you find something, but know that:

• Finding a lump or any other change doesn’t always mean it’s cancer
• It’s also important to know that performing a breast self-exam doesn’t replace getting regular mammograms or getting your annual exams by your doctor

Mammogram recommendations

For people at average risk of breast cancer, the ACS recommends that women get yearly mammograms to screen for issues starting at age 45, though you can opt to start them earlier at 40 years old.

If you fall into a high-risk category for breast cancer, the ACS recommends that starting at age 30, you get a breast MRI and a mammogram every year to screen for concerning changes and detect any issues early.

If you’re not sure about your breast cancer risk and which category you fall into, check with your primary care doctor.