Breast health

Breast self-exam — a good idea

by Dixie Mills, MD, FACS

• Breast self-examinations — nothing to fear
• The controversy about breast cancer and BSE
• How to perform a breast self-exam your way
• Breast massage techniques

As a longtime physician specializing in breast health, I have seen many changes in the medical paradigm: imaging technology has improved; we have more surgical and treatment options; and there has been an explosion of clinical trials and studies focused on breast cancer. A few years ago, certain research raised questions about monthly breast self-examinations (BSE) that some of us did not expect, but the results have gotten lost in the media frenzy about mammograms.

In fact, when it comes to BSE, lots of women are still asking: should I or shouldn’t I? Does it matter?

We all have our own relationships with our unique body parts, and our breasts are no exception. Some women see their breasts only as others see them. Others see “their girls” as disembodied entities that are taken out occasionally for sex or breastfeeding. Lots of women see their breasts as important and cherished parts of their identity. Accepting and loving your breasts as integral elements of your amazing body creates lots of potential benefits.

But even more important is to feel comfortable with yourself and your body. If you don’t want to do a monthly breast self exam for whatever reason - you can’t remember; you are too worried to do it; touching your breasts gives you the creeps - you don’t have to. There are no BSE police out there, although some health care providers can make you feel that way. Your emotions and instincts are key elements of your overall health and they should never be ignored. There are options to BSE that can help you support your breast health, if and when you choose to.

I think that when women establish any kind of respectful and friendly connection to their breasts, it does wonders for their self-image and health, both physical and emotional. Let’s look more closely at BSE — what it is and what it isn’t — and then you can decide what is best for you.

BSE: How about calling it breast self-exploration instead?

In my medical opinion, checking in with your breasts does not have to be a “search and destroy” mission, where the one and only goal is to scout out irregularities and disease. I still recommend women perform BSE, though my reasons and focus may be different from most conventional physicians’.

Many women live in fear of breast problems, while others reluctantly submit to “examining” their breasts each month. It might help women overcome their hesitation about breast self-examination if we transformed the process and called it breast self-exploration instead.

I’ve met women who are put off by the thought of touching their breasts, perhaps because, as children, they were taught that it’s “wrong” or “dirty.” In truth, there are lots of reasons women might be uncomfortable with the idea. But if it feels right for you, you can change your perception of your physical self and how you feel about your breasts.

You may learn to appreciate, love, and honor these remarkable organs of both your reproductive and endocrine systems. Over the course of your life, your breasts will change and the better you know your breasts across all life’s stages, the more you will trust your own intuition when it comes to breast health.

Why is there a controversy about breast self-exam anyway?

For years, women were advised to perform monthly BSE in order to screen and find any abnormalities early on. And it’s true that the vast majority of breast lumps (of all types) are discovered by women themselves, through BSE, or “accidentally” during the course of regular life: in the shower or lying in bed, or perhaps by a partner.

Even so, studies show that:

• BSE does not prevent cancer — a breast self-exam is not like brushing one’s teeth to prevent cavities.
• BSE may — or may not — lead to finding an abnormality “earlier.” Over the past decades, there have been studies, large and small, around the world, but the research results are still mixed.
• BSE has not been shown statistically to reduce death rates from breast cancer.
• BSE has been shown to lead to significantly greater numbers of biopsies and/or surgeries for what turn out to be benign lumps.

And aside from these assorted research results, women may have their own issues with BSE. They may worry about performing it the “right” way, or want to only have it done by their doctors. Some women are so worried about “finding something,” that just thinking about BSE gives them the heebie-jeebies! If you don’t want to perform a breast self-examination — please, honor this deeply personal choice. Perhaps it would feel right for you to have your doctor give you a breast exam during an annual visit.

No matter who performs your breast exam, it isn’t guaranteed you would detect a cancerous tumor early. While BSE helps you learn a lot about what’s going on under the skin, it is difficult in the midst of breast tissue to feel any cancerous lump that is smaller than a raisin. And some types of cancer, like lobulars, are notoriously difficult to feel until they are almost the size of a small lemon!

When — and if — you do notice anything different in your breast, know that the overwhelming majority of breast changes do not turn out to be cancer.

BSE does not have to be a clinical-type exam, and it shouldn’t hurt when you do it — at all. It’s simply a wonderful opportunity to see your breasts as normal, natural extensions of your body. It’s good to acknowledge that - and maybe even celebrate it!

Take the fear out of BSE by knowing what’s “normal” for you

Regular BSE helps you know what’s normal for your breasts and it’s likely you will notice changes over time. Lumpy breasts are very common and may be categorized as fibrocystic breast condition by doctors. This is reported to affect 60% of all women and although these kinds of lumps may cause discomfort, they are not cancerous.

Lumpy breasts — and even breast tenderness — often result from hormonal fluctuations associated with your monthly cycle. Taking steps to create balance between estrogen and progesterone helps maintain healthy breast tissue.

Fibroadenomas are another kind of very common finding. This kind of lump is made of fibrous tissue and may feel rubbery or hard. Typically, fibroadenomas have clearly defined edges and are easy to move around within the breast. Sometimes they are biopsied (sampled and studied), but they are generally benign.

After menopause, dense or lumpy breast tissue often “clears” or becomes less dense. And breast size and shape can change, up or down, during this time. Happily, monthly breast tenderness or pain often subsides at menopause or disappears altogether.

Okay, you’re going to give BSE a try... Now what?

Some women enlist the help of their doctors to learn BSE and follow a methodical series of steps to check all areas of the breast and underarm where lymph nodes are located. You can also find any number of illustrations and video guides on the internet - and even cell phone apps! — to guide you through this type of breast self-exam.

If you want to redefine BSE as an exploration, remind yourself that the goal is to become familiar with your breasts, not to be stressed about your “technique!” While it’s good to do a visual check in the mirror, remember that your own two breasts will look different from each other. Cartoon drawings of busty women aside, real breasts are not perfectly symmetrical.

I think it helps to concentrate on breathing deeply throughout a breast self-examination. Deep, regular breathing can help you stay relaxed and it also keeps air, energy, and lymphatic fluids flowing.

If you choose, you can perform BSE in the shower or even use the FDA-approved, over-the-counter BSE “pad.” Either option can improve touch sensation and reduce friction. You can perform BSE monthly, weekly, or even daily. If menstruating women perform BSE a few days after their periods, their breasts are usually less lumpy and tender.

Massage and meditation

Another wonderful technique to check in with your breasts on a regular basis is breast massage. Breast massage can relieve breast pain and tenderness, along with tension and stress, and can help get lymph fluid moving. It also sends positive messages to your breasts that say, “Girls, you are safe with me!”

For massage, I prefer using only light pressure, with gentle gliding motions. I don’t think squeezing, kneading, or twisting motions are necessary or helpful. You can use massage oil, castor oil packs, cocoa butter, bath or shower oil, or even practice with your clothes on — but probably not in a public place — yet! The massage can be super short, or it can last about four minutes — two minutes per side. You can also extend the session to 20 minutes. (See my CD, “Honoring Our Breasts: A Guided Self-exam to Music.”) Breast massage can be done every day.

Some women like to start with a feel-good affirmation they repeat throughout the massage. Begin by rubbing your palms together, fingers flat, to find the appropriate pressure and comfortable technique for stroking your breasts gently. Keep the fingers extended and use the flat side of the palm and fingers. The pressure should not be painful or noticeably stimulating. If you have very sensitive breasts, you may want to practice while wearing a t-shirt.

Here is my technique for breast massage:

Start by stroking upward from below the breast, over to the side, and up into the armpit, repeating at least five times. Do an extra five just under the armpit and stretch the skin up. Now bring the hand over the breast, near your collar-bone and stroke five times toward the neck. Then stroke over the center of the breast and nipple from under to the collar bone — repeat five times. Stroke five times from the nipple area toward the breast bone — then up from below the breast to the notch where your collarbones meet.

Repeat the process for the other breast, using your other hand. Try not to worry about what you’re feeling physically. Instead, focus on the energy, blood, and lymph you are helping to circulate.

Close with crossing your arms and repeating your affirmation. Shorten the massage by doing each movement only twice, or lengthen it by repeating movements ten times. Add any other motions that feel “right” for you.

Your body and your breasts are already perfect — for you!

I hope you will consider breast self exam as an opportunity to discover what normal, healthy tissue feels like. If you do try breast exploration or massage, it’s especially lovely when you can breathe in compassion, peace, and goodness, and breathe out fear and anxiety. As you come to know what’s “normal” for you and then happen to notice any changes, you can remind yourself that information is an important part of staying healthy.

Your breasts are your buddies, not time bombs that will “do you in.” They are more than sexual objects pictured in magazines, and it isn’t shameful to know them well — it’s liberating and reassuring.

Maybe we should all take a moment to thank our breasts — and our bodies — for all the wonderful, beautiful things they do for us every day!

(For more information on breast self-care and breast cancer prevention, see 5 simple ways to create optimal breast health.)

Related to this article:

References & further reading on breast self-examinations

 

Last Modified: 12/05/2011
Principal Author: Dixie Mills, MD