Breast exams serve as a screening method to monitor breast health. These examinations involve both visual inspection and physical palpation of the breast tissue. Clinical breast exams, performed by healthcare professionals, and self-breast exams, conducted by individuals, are valuable tools. The goal of these exams is to identify changes or abnormalities in the breast that may warrant further investigation.
The Clinical Breast Exam Procedure
A clinical breast exam (CBE) is performed by a trained healthcare professional, such as a doctor or nurse practitioner, during a yearly physical check-up. This examination begins with a visual assessment of the breasts while the patient is seated. The healthcare provider observes the breasts for differences in size or shape, skin changes like rashes or dimpling, or nipple alterations such as inversion or discharge. They may ask the patient to raise their arms overhead or press their hands on their hips to accentuate changes.
Following the visual inspection, palpation occurs with the patient lying down. This position spreads breast tissue evenly across the chest wall, making abnormalities easier to feel. The healthcare provider uses the pads of their fingers to systematically feel the entire breast, underarm, and collarbone areas, applying light, medium, and firm pressure. They look for lumps, areas of thickening, or tenderness. Clinical breast exams are recommended every 1-3 years for women aged 25-39 and annually for women aged 40 or older.
Performing a Self-Breast Exam
Performing a self-breast exam (SBE) allows individuals to become familiar with the normal look and feel of their own breasts, helping them notice changes. This process involves both visual and manual steps. Begin by standing in front of a mirror with arms at your sides, observing your breasts for any changes in size, shape, symmetry, skin dimpling, puckering, or nipple alterations. Next, raise your arms over your head and then press your hands on your hips, flexing your chest muscles, to check for visible changes with movement.
For the manual palpation, which can be done while standing in the shower or lying down, use the pads of your three middle fingers. Apply light, medium, and firm pressure to feel all parts of the breast tissue, including the area extending into the armpit and up towards the collarbone. Many individuals find it helpful to follow a consistent pattern, such as a circular motion or a vertical strip pattern, to ensure all areas are covered. Gently squeezing the nipple to check for any discharge is also part of the exam.
The ideal time to perform a self-breast exam for menstruating individuals is a few days to about a week after their period ends, when breasts are less tender and swollen due to hormonal fluctuations. For those who have reached menopause or have irregular periods, choosing a specific day each month and performing the exam consistently on that day helps establish a routine. While self-exams are a useful tool for personal breast awareness, they are complementary to clinical exams and mammograms, not a substitute for professional screening.
Understanding Exam Findings and Next Steps
Discovering a change during a breast exam, whether clinical or self-performed, does not indicate a serious condition. Many breast changes are benign and not related to cancer. However, any new or unusual findings, such as a lump, changes in skin texture, nipple discharge, or persistent pain, should be discussed with a healthcare provider for further evaluation.
Upon reporting a concerning finding, a healthcare provider will recommend additional tests to determine the nature of the change. These next steps begin with less invasive diagnostic imaging, such as a diagnostic mammogram, which takes more detailed images than a screening mammogram. A breast ultrasound may also be performed, especially to differentiate between a fluid-filled cyst and a solid mass. A breast MRI might also be recommended for a comprehensive view.
If imaging tests do not provide a clear diagnosis or if a suspicious area remains, a biopsy may be necessary. A biopsy involves removing a small sample of breast tissue or cells for laboratory analysis to determine if cancer cells are present. These follow-up evaluations are important for obtaining an accurate diagnosis and guiding treatment.