Are Self-Breast Exams Necessary? What Women Need to Know

Evidence is growing that monthly self-tests don’t reduce deaths from breast cancer, but you shouldn’t ignore your breasts, either. These key insights could clear up the confusion—and potentially save your life.

Your breasts are naturally lumpy and bumpy

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The breast is a lumpy organ, says Seema Khan, MD, professor of surgery at Northwestern University’s Feinberg School of Medicine. It’s helpful to know this, as women performing monthly self-exams endure a lot of unnecessary anxiety, testing, and biopsies after detecting what ended up being completely normal lumps and bumps. Get to know the architecture of your breasts, including which parts tend to be lumpier than others, so you can identify any changes if they occur. Be on the lookout for changes in the size or shape of the breast, discharge, and any itching, swelling, thickening, dimpling or other differences in the skin. (Related: These are breast cancer symptoms you shouldn't ignore.) “If you suspect a change, contact your health care provider immediately so it can be evaluated,” advises Therese Bevers, MD, medical director of the Cancer Prevention Center at MD Anderson Cancer Center in Houston, Texas. “If it feels different to you, you should take action.” For perspective, here are other things that lump in your breast could be besides cancer.

Your breasts change around your period

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Your menstrual cycle plays a large role in the texture of your breasts—they feel lumpiest and most tender right before your period due to a rise in estrogen and progesterone levels. “If the breast feels different right before a period, let the period happen before you check again and then decide if you need to see a doctor or not,” Dr. Khan says. The best time to check your breasts is right after your period, when the tenderness dissipates and the lumpiness should return to your natural baseline. If it doesn’t, it might be time to set up a doctor’s appointment.

You can help prevent breast cancer

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Modifiable risk factors for breast cancer include diet, physical exercise, maintaining a close-to-ideal body weight, and consuming alcohol in moderation. “We recommend a standard healthy diet rich in fruits and vegetables and whole grains, and low in animal fats and proteins,” says Dr. Khan. She also recommends boning up on calcium from a variety of sources including dairy and greens. When it comes to alcohol, the risk goes up a little bit with every drink beyond three or four per week, though it’s probably okay to have one alcoholic beverage a day, according to Dr. Khan. Check out the little daily habits that can help keep cancer away.

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You should know your personal breast cancer risk

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All women should practice breast self-awareness, which is basically knowing the architecture of your breasts and being aware of changes. However, it’s also important to know whether you’re technically at higher risk of developing breast cancer, because if so, you may need different types of screening or more frequent screening. (Read more about the latest breast cancer screening guidelines.) Risk factors include: family history of breast cancer, advancing age, obesity (especially in postmenopausal women), and use of hormones, especially the combination of estrogen and progesterone, according to Dr. Bevers. Women with high-risk breast lesions found on a breast biopsy are also at high risk. “For higher-risk patients, we actually do different types of screening than for an average risk patients,” Dr. Bevers says. “I may see you every six months instead of once a year, and do a breast exam and imaging every six months, alternating between mammogram and MRI.”

You’re more likely to notice irregularities on the fly

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In 2013, the United States Preventive Services Task Force recommended against teaching women how to perform breast self-exams—because that’s not when most abnormalities are found. “The vast majority of breast cancers are found by women not during breast exams, but during activities of daily living—showering, dressing, scratching, applying lotion, things like that.” Dr. Bevers says. “That’s why the focus has shifted to breast awareness.” (Related: Read up on the secrets your breasts won’t tell you, but that you should definitely know.)

If you do feel something abnormal, take action

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Don’t wait until your annual screening. “If you feel something and it doesn’t go away after your next period, make sure you come in and get diagnostic imaging, usually a mammogram and ultrasound,” says Heidi Memmel, MD, director of breast surgery at Advocate Lutheran General Hospital in Park Ridge, Illinois. Mammograms are great screening tools, but they don’t work as well for dense breast tissue, which is very common, according to Dr. Memmel. Dense breast tissue shows up white on mammograms, as does cancer, making tumors more challenging to spot. Detection is easier with ultrasound, which is better for diagnosis and pinpointing the exact area of concern. If you feel something suspect, ask for a diagnostic mammogram, ultrasound, or MRI.

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Usually a lump is nothing

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Rest assured: If you do find an abnormality, it will probably be benign. On diagnostic evaluation of abnormal findings, including abnormal mammograms, only 10 to 20 percent turn out to be breast cancer, according to Dr. Bevers. It’s still a good idea to be evaluated, though, just to be safe. (Related: Don’t fall for these breast cancer myths.)

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