A Breast Self-Examination (BSE) is a personal check that allows a person to become familiar with the usual look and feel of their breasts. This practice helps establish a baseline understanding of what is normal for an individual’s body. Historically, the BSE was promoted as a primary screening method for breast cancer, but medical guidance has since shifted its focus toward general breast awareness. Noticing changes quickly allows you to discuss them with a healthcare professional.
Current Medical Recommendations on BSE
The medical community has moved away from mandating the Breast Self-Examination as a formal, routine screening tool for the average person. Major organizations, such as the U.S. Preventive Services Task Force (USPSTF), recommend against teaching routine BSE, citing a lack of clear evidence that it reduces breast cancer mortality. This shift occurred because studies showed that regular BSE, while increasing the detection of benign changes, did not necessarily improve survival rates.
The current recommendation centers on “breast awareness,” which encourages individuals to be generally observant of their breasts’ appearance and feel, rather than adhering to a strict, structured monthly exam. The American Cancer Society (ACS) acknowledges that self-exams may be comforting for some people who wish to actively monitor their breast health, but they are not a required part of the formal screening schedule.
Timing and Frequency of the Examination
For those who choose to perform a structured self-exam, the universally recommended frequency is once per month. Performing the exam monthly at a consistent time allows a person to track subtle changes and establish a reliable baseline.
Pre-Menopausal Individuals
Pre-menopausal individuals should aim to perform the examination three to five days after the start of their menstrual period. This specific timing is optimal because hormonal fluctuations cause breast tissue to be least swollen and tender immediately following the end of menstruation. Examining the breasts during this period reduces the likelihood of feeling temporary lumps or tenderness that are a normal part of the menstrual cycle.
Post-Menopausal or Non-Cycling Individuals
For individuals who are post-menopausal, pregnant, breastfeeding, or who do not have a menstrual cycle, the advice is to simply choose a consistent, easy-to-remember day each month. Selecting a fixed date, such as the first or last day, helps ensure the monthly check is not forgotten and maintains a consistent schedule.
Step-by-Step Guide to Performing a BSE
The self-exam involves both visual inspection and manual palpation to cover the entire breast area systematically.
Visual Inspection
The process begins with a visual check in front of a mirror with the hands placed first at the sides, then raised overhead, and finally pressed against the hips to flex the chest muscles. This visual check aims to identify changes in size, shape, symmetry, skin texture like dimpling or puckering, or any changes in the position of the nipples.
Manual Palpation
The physical examination is best performed lying down, as this position spreads the breast tissue more thinly and evenly across the chest wall, making it easier to feel for deep changes. Using the pads of the three middle fingers, not the fingertips, a person should apply varying levels of pressure—light, medium, and firm—to feel all tissue layers down to the rib cage. The examination should cover the area from the collarbone down to the top of the abdomen, and from the armpit to the breastbone.
Shower Check
Many people find it useful to perform a final check while standing in the shower, as the wet, soapy skin allows the fingers to glide more smoothly over the tissue. During this phase, a person should use a consistent pattern, such as a vertical strip or circular motion, to ensure no area of the breast tissue is missed. The entire area, including the tissue extending into the armpit, should be thoroughly checked.
Identifying and Responding to Changes
While a lump is the most commonly recognized sign, other changes also warrant immediate attention, such as persistent pain in one area or an unexplained change in the breast’s size or shape. Skin changes like redness, scaling, or an orange-peel texture (peau d’orange) should be noted, along with a nipple that suddenly turns inward or produces a clear, bloody, or unusual discharge.
It is important to remember that most breast changes discovered during a self-exam are benign and not indicative of cancer. However, any new finding must be evaluated by a healthcare professional immediately. Reporting the change promptly allows for professional diagnostic imaging, such as a diagnostic mammogram or ultrasound, to determine the cause.