Breast self examination is an important, potentially life-saving procedure. It should be known and practiced by all women. Because the majority of breast masses are detected by women themselves, monthly self breast examination, in combination with regular, annual, professional examinations and periodic mammography offers the best chance of reducing the risks of advanced breast cancer. The best time to examine the breasts is immediately following a menstrual period. The breasts are the smoothest (least lumpy) and easiest to examine at this time. The completion of a menstrual period is a convenient reminder to examine the breasts.

Breast Self Exam Detects the majority of breast abnormalities Potentially life-saving Monthly exam, at end of menses Start in front of mirror Begin with a close inspection of the breasts in the mirror.

Inspect for: Skin changes Redness Visible bumps Nipple crusting Symmetry Look for any dimpling or unusual skin changes. There should be no visible bumps or bulges of the breast beyond the normal contour. The skin should be a uniform color and not have areas of redness suggesting increased blood flow. The nipples should have no visible secretions or crusting.

Raise Arms Up Breasts should rise evenly Watch for dimpling or retraction Watch in the mirror as you raise your arms over your head. The breasts should rise and there should be no change in shape. Some breast problems cause a portion of the breast to become adherent to the chest wall. In such cases, when the arms are raised, the "stuck" portion of the breast remains in place while the rest of the breast rises. This causes "dimpling" or "retraction" of the skin over the stuck portion of the breast.

Feel for Lumps Raise the arm Feel with opposite hand Feel for a “marble in a bag of rice” With one arm raised begin feeling for lumps or masses with the opposite hand. Raising the arm is helpful because it stretches the pectoralis major muscle (the large muscle under the breast) and lifts the breast up, creating a more solid, smooth surface on which to examine the breast. All breasts feel a little "lumpy," but remember that you are not feeling for tiny nodules, but rather for larger lumps. You are feeling for "a marble in a bag of rice."

Use the Middle of Your Fingers Fingertips are too sensitive (all breasts are somewhat lumpy) Palm is too insensitive Middle portion of fingers is just right Don't use your fingertips...they are too sensitive and you will end up focusing on all the tiny irregularities and nodules that are present in everyone's breasts. Don't use the palms of your hand...they are too insensitive and you can miss something important. Use the middle portions of your fingers...they have just the right sensitivity for finding the lumps or masses you are seeking.

Move your hand in small circles Stay in one place Press in while circling with your hand Feel for thickenings the size of a marble Move your hand in small circles while feeling for lumps

Then move to another location Work your way around the breast in a clockwise fashion, using small circles of the hand as you go. Make sure the entire breast is felt. After examining the first area with circular motions of your hand, move to another area and again feel for lumps, using a circular motion. Many people find it easiest to progress in a clock-wise fashion around the breast until the entire breast has been examined.

The “Tail” of the Breast Breast is not perfectly round. A “Tail” of breast tissue normally extends into the armpit. Make sure to feel for lumps in that portion of the breast. Remember that the breast is not perfectly round, but has an extension ("tail") that extends up into the armpit. It is important to examine that portion of the breast too.

Feel the Armpit Use the same circular motions. Feel for breast lumps and lymph nodes. Normal lymph nodes cannot be felt. Enlarged lymph nodes are about the size of a pencil eraser, but longer and thinner. Using the same circular motions, examine the armpit, feeling for any lumps in the "tail" of the breast or any lymph nodes. Lymph nodes are normally so small they cannot be felt. If enlarged due to infection or inflammation, they grow to about the size of a pencil eraser but are long and narrow rather than round.

Try to Express Nipple Discharge Strip the ducts towards the nipple. Normally, one or two drops of clear, milky or green-tinged secretions. Should not be bloody or in large quantity, squirting out or staining the inside of a bra. Using the thumb and fingers, squeeze the breast toward the nipple to try to express any discharge. This stripping of the milk ducts can be useful in identifying early problems with the ducts. You should squeeze not only from side to side, but also from top to bottom and at an angle. In normal breasts, you can, with effort, usually produce a drop or two of clear, milky, or slightly green-tinged discharge. Abnormal findings would be a bloody discharge, or so much discharge that it squirts across the room or consistently stains the inside of your bra.

Now Check the Other Side Follow same maneuvers. Raise the arm above your head. Feel for lumps or masses. Then move to the other breast, performing the same maneuvers.

Have a Professional Breast Exam Each Year Basically the same maneuvers Ask questions In addition to your monthly breast self-examinations, an annual professional exam by a physician or other qualified health professional is important. At that time, you can ask questions about findings that you didn't consider abnormal but were nonetheless troubling.

Mammograms Age 40-50: Every other year Over Age 50: Annually Might be more often in special circumstances such as breast problems, family history of breast cancer. Mammography is the final part of routine breast screening. For women without significant breast disease or a family history of breast cancer , mammography is probably useful about every other year from age 40 to age 50. After age 50, most health providers recommend annual mammograms. Check with your own health care provider to find out what would be best for you.

If you find something in your breast... Don’t panic. Most (90%) of breast lumps are benign. Do see a physician or other qualified health care provider right away.