Breast cancer: Breast self-examination

The most effective way to fight breast cancer is to detect it early. Although the most effective tools to detect breast cancer are mammography and clinical breast examination by your doctor, in fact, women who perform routine breast self-examinations find 90 per cent of all breast masses.

What is breast self-examination and why should I do it?

Breast self-examination is a way 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 of surviving the disease are greatly improved. While 80 per cent of all breast lumps are not cancerous, you can help catch potentially serious changes in the breast early by routine self-examination.

The NHS recommends being “breast aware”, as knowing what is normal for you will help you to be aware of any changes.  Looking at and feeling your breasts regularly allows you to become familiar with your breast tissue. This should be done in the way that is most comfortable for you (for example, in the bath or shower, or when dressing).  It is good to start breast self-examination in your twenties. Over time, you will become more familiar with the contours and feel of your breasts, and will be more alert to anything new.  Remember, before the menopause a woman’s breasts may feel different at different times of the menstrual cycle, especially in the days just before a period starts.

The NHS “breast awareness” five-point code recommends that women:

• Know what is normal for you
• Look and feel
• Know what changes to look for
• Report any changes without delay
• Attend for breast screening if aged 50 or over.

What to look out for

It is important to know what to look and feel for, in particular:

• An area that is distinctly different from any other area on either breast.
• A lump, bumpy area or thickening in or near the breast or in the underarm area that persists through the menstrual cycle.
• A change in the size, shape or contour of the breast, especially those caused by arm movements, or by lifting the breasts.
• 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, red or inflamed).
• Discomfort or pain in one breast that is different from normal, particularly if new and persistent.
• Bloody or clear fluid discharge from the nipples.
• Any change in nipple position - e.g. pulled in or pointing differently.

Interestingly, cancerous tumours are more likely to be found in certain parts of the breast. If you divide the breast into four 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 doctors refer to this region as the "tail" of the breast and encourage women to examine it closely.