How to Do a Breast Self-Exam, and What to Look For, According to Oncologists

Preventive breast health starts at home.

<p>Drazen Zigic / Getty Images</p>

Drazen Zigic / Getty Images

As a young, healthy woman, I’d admittedly never put much thought into being diagnosed with breast cancer until I spent a week in back-to-back doctor’s appointments, clinical breast exams, and ultrasounds. Let’s back up, shall we? I went to my gynecologist for an annual checkup in May, when my doctor felt something abnormal during my breast exam. “I’m almost positive it’s nothing, but I’m going to order an ultrasound just to be safe,” she said. “Can you feel how this area is a little different?” (Honestly? No. I’d never thought of doing a self-exam, so my breasts’ topography was foreign terrain.)

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I booked my ultrasound a few hours before my fiancé and I were supposed to take off for a relaxing trip to Hawaii. While my ultrasound showed the area in question to be just fine, a scooch of the transducer wand showed a darker, irregular area that the radiologist rated a BIRADS-4 and said should be biopsied when I returned from my trip. (For those of you who are unfamiliar with radiology, that’s not a good thing.) Suffice to say, the bulk of my “relaxing” Hawaii trip was spent feeling like upcoming milestones, like my 30th birthday and 2023 wedding, weren’t guaranteed. It was terrifying.

I am so thankful that, ultimately—after many, many appointments, second opinions, and third opinions—my BIRADS-4 rating was downgraded to a BIRADS-1 (a false positive, if you will). However, I know that’s not the case for anyone. (Who knows? Future me isn’t exactly clear either.)

Research shows that one in eight women will be diagnosed with breast cancer in their lifetime. And, while the median age of diagnosis is 62 years old, it can still happen to women under 40 years old, which is when most women are encouraged to start regular mammograms.

While breast self-exams are sometimes met with trepidation—some doctors firmly believe that mammograms and ultrasounds are the best ways to detect any changes—self-exams do have their perks. “It’s a good idea generally to be aware of changes in your body, and self-examination can be a part of that,” says surgical oncologist Lydia Choi, M.D., FACS, of the  Karmanos Cancer Institute in Michigan. “Women are sometimes the first to notice lumps in the breast and can find lumps that don't appear on screening mammograms.”  In fact, Johns Hopkins Medical Center found that 40 percent of breast cancers are detected by women who feel a lump in their own breast.

So, the big question: How do you conduct a self-exam? (Before my health scare, I had zero clue.) Since breast health should be a year-round conversation—and not only during Breast Cancer Awareness Month each year—three experts are here to break down everything you need to know about the process.

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Who Should Do Breast Self-Exams?

If you identify as female and have gone through puberty, it’s a good idea to start checking yourself. “During adolescence when puberty is taking place, [young women] should begin to become aware of their breasts and the changes that occur,” explains Ahkeel Allen, M.D., board-certified breast surgical oncologist at HCA Florida Mercy Hospital. “After puberty, they should continue to familiarize themselves with their breasts and conduct self-breast exams.” Though men are typically not recommended to do breast self-exams, Dr. Allen encourages men to become familiar with their nipple area, as 1 percent of breast cancer does occur in men.

How Often Should You Conduct a Self-Exam?

Though Dr. Choi admits breast self-exams can be a controversial topic—as many experts believe mammograms and ultrasounds are the best screening tools—she says that those who want to check themselves should do so once a month around the same time. “Usually three to five days after the menstrual cycle is best,” she says.

What's the Best Place to Do It?

As for where you should conduct your breast self-exam? According to Irene M. Kang, M.D., medical director of women’s health oncology at City of Hope County in Orange County, Calif., in the shower is a great place to check your breast area, since “it’s easier to move your fingers over wet skin.” Another excellent option is to conduct a second self-exam while you lie down on your bed.

How to Conduct a Breast Self-Exam

This may come as a total surprise to you, but a breast self-exam requires more than touching your boobs. “Many women are surprised to learn that the breast lies over a large muscle called the pectoralis major muscle, which goes from just below the collarbone to the armpit and across the breastbone,” Dr. Kang explains. “It’s a good idea to cover all these areas during your self-exam.”

For best results, Dr. Allen says it’s a good idea to use your opposite hand to feel your armpit as well as the area from your clavicle to infra-mammary fold (a.k.a where your lower breast tissue meets the chest wall.) To ensure you’re feeling everything, you might want to raise that idle arm above your head for good measure.

“Use the pads of the middle three fingers and sweep around the breast in a pattern—either in concentric circles, side-to-side, or top-to-bottom—to feel the entire breast,” Dr. Choi says.

What to Look (and Feel) For

Look for Visual Changes

Before you go into the shower (or lie down), for example, step in front of the mirror and look for visual changes. (Turns out, seeing something unusual can also be an indicator that you need to visit a doctor.) “This includes swelling, rashes, soreness, changes in skin color, areas that feel warm to the touch, dimpling, puckering, bulging skin, and, of course, a lump in the breast,” Dr. Kang explains. “Also, look for changes in the nipple, such as inverting or changing position.”

Feel for Irregularities

Though any changes in your breast’s appearance or texture should be examined by a medical professional, Dr. Kang says there are often small differences between the texture of cancerous and non-cancerous lumps. “Generally, a smooth lump that moves easily [between your finger pads] is not cancerous,” she says. “Breast cancers are typically painless, hard, immovable, and irregularly shaped. [That said], you can’t know for sure and should not self-diagnose, so you’ll want to check with your doctor to be certain.”

You Felt or Saw Something—Now What?

I know personally how terrifying it can be to feel a lump or hear that something isn’t quite right; however, it’s important to contact your doctor ASAP. Your healthcare provider or OBGYN can conduct their own exam, order mammograms and ultrasounds, or connect you to a breast care specialist, if needed. While it’s so easy and natural to get caught up in the “what ifs,” take a breath and remember that advocating for yourself is the best thing you can do—especially in a medical setting.

“Don’t panic, but don’t hesitate to report these changes to your doctor,” Dr. Kang shares. You are never bothering your doctor or being dramatic, and the old adage of “better safe than sorry” rings especially true in a scenario like this. “Remember, catching breast cancer in its earliest stages means you have a greater chance for a better outcome.”

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