Ahmed Safa, MD
Jennifer Turchetta, NP
Northeast Oncology Associates, a Member of Beth Israel Lahey Health

Self-Exam 101

Make breast self-examinations routine. The more you examine your breasts, the easier it will become for you to tell if something has changed. Get in the habit of doing a breast self-examination at least once a month. Examine yourself at least 3-5 days after your period starts, when your breasts are least likely to be tender or lumpy. If you are no longer having periods, choose a day that’s easy to remember, such as the first or last day of the month.

If you think you feel a lump in your breast, don’t panic. It is common to have lumps or lumpy areas in the breast all of the time, and most breast lumps turn out to be benign (not cancerous). However, do not hesitate to call your doctor if you’ve noticed a lump or other breast change that is new and worrisome, especially changes that last more than one full menstrual cycle, or a lump that is getting bigger.  

At an appointment to evaluate a breast lump, your doctor will take a health history and do a physical exam of the breast, and will most likely order breast imaging tests which may include an ultrasound, mammogram or MRI (magnetic resonance imaging). Your doctor may also refer you to a breast specialist at a breast health center for further evaluation.

All About Mammograms

Different organizations have different recommendations for screening mammograms. According to the American Cancer Society, screening mammograms are recommended as follows:

• Women aged 40 to 49 years
  • Women 40 to 44 years have the option to have yearly mammograms, if you wish to do so. Be sure to discuss the potential benefits and risks of screening with your doctor.
  • Women 45 to 49 years should have yearly mammograms.

• Women aged 50 to 74 years
  • Women 50 to 54 years should have yearly mammograms.
  • For women 55 years and older, mammograms could occur yearly, or every two years. Discuss this option with your doctor.

• Women aged 75 years and older
  • Women 75 years and older should continue getting mammograms as long as your overall health is good and you still wish to continue with screening.

What’s My Risk?

In general, the average lifetime risk of women developing breast cancer is less than 15%; however, some women are at a moderate risk (15 to 20%) or high risk (greater than 20%) of developing breast cancer in their lifetime.

It is important to know your risk so your provider can use that information to recommend the type of breast cancer screening and the frequency of screening. Your provider can also determine if there is any indication for genetic testing, preventative hormonal therapy or risk-reducing surgery.

There are several factors to determine a woman’s risk category. These include:

• Personal and/or family history of breast or gynecological cancer (ex. ovarian, tubal, or peritoneal)
• Ancestry (ex. Ashkenazi Jewish) associated with BRCA1 or 2 mutations
• Known genetic mutations associated with breast or ovarian cancers in yourself or a relative
• Dense breast tissue as identified on a mammogram
  • Dense breast tissue is associated with a higher risk of breast cancer. Additionally, dense breast tissue can conceal a small tumor which can interfere with accurate mammograms readings.
• Previous pre-cancerous cells in the breast(s) (ex. Atypical hyperplasia)
• Reproductive factors (early onset of menstruation, late onset of menopause, later age at first pregnancy or never having given birth)
• Radiation to the chest between ages 10 to 30

For moderate-risk women, the general recommendation is to follow the same screening guidelines as average-risk women.  However, for high-risk women, the American Cancer Society recommends having a breast MRI with screening mammograms, and referral to a high-risk breast clinic for close follow-up and to review potential risk-reduction treatments.

Survivorship

In general, the survival rates of breast cancer are favorable, especially if it is caught early.  The prognosis of breast cancer has improved most likely due to increased screening with earlier diagnosis, and improved treatments. 

Survival depends on many different factors which include the type and stage of breast cancer, your physical fitness level and which cancer treatments you have already received (if applicable).  A national database (Surveillance, Epidemiology, and End Results (SEER)) predicts survival rates based on how far the cancer has spread:

• Localized: There is no sign that the cancer has spread outside of the breast.
• Regional: The cancer has spread outside the breast to nearby structures or lymph nodes.
• Distant: The cancer has spread to distant parts of the body such as the lungs, liver or bones.

5-year relative survival rates for breast cancer

These numbers are based on women diagnosed with breast cancer between 2012 and 2018.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Self-Exam: How-To

1. Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.
   1. Look for: breasts that are their usual size, shape and color; evenly shaped without visible distortion or swelling
   1. If you see any of the following changes, follow up with your doctor: dimpling, puckering, bulging of the skin; a nipple that has changed position or an inverted (pushed inward); redness, soreness, rash or swelling.
2. Raise your arms and look for the same changes.
3. While you are at the mirror, look for nipple drainage or discharge (this could be watery, milky or yellow fluid or blood).
4. Feel your breasts while lying down, using your right hand to feel your left breast, and then your left hand to feel your right breast. Your doctor can teach you the following techniques:
   1. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together.
   1. Use a circular motion, about the size of a quarter.
   1. Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.
   1. Follow a pattern to be sure that you cover the whole breast.
   1. Use light, medium and firm pressure to feel all layers of tissue.
5. Feel your breasts while you are standing or sitting. Many women perform this step in the shower. Cover your entire breast, using the same hand movements described in step 4.

Video demonstration: https://moffitt.org/cancers/breast-cancer/faqs/how-to-do-a- self-breast-exam/

References

American Cancer Society. (2022, January 14). American Cancer Society Recommendations for the Early Detection of Breast Cancer. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html

American Cancer Society. Cancer Facts & Figures 2022. Atlanta, Ga: American Cancer Society; 2022.

American Cancer Society. (2022, March 1). Survival Rates for Breast Cancer. https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html

Berg, C. D. (2016). Breast Cancer Screening Interval: Risk Level May Matter. Annals of Internal Medicine, 165:737. https://doi.org/10.7326/M16-1791

BreastCancer.Org. (2022, June 29). Breast Self Exam (BSE). https://www.breastcancer.org/screening-testing/breast-self-exam-bse

Elmore, J. G., Reisch, L. M., Barton, M. B., et al. (2005). Efficacy of breast cancer screening in the community according to risk level. Journal of the National Cancer Institute, 97(14): 1035-43. https://doi.org/10.1093/jnci/dji183   

National Institutes of Health. (2020, December 16). Breast Cancer Risk in American Women. National Cancer Institute. https://www.cancer.gov/types/breast/risk-fact-sheet

National Institutes of Health. (2022). Cancer Stat Facts: Female Breast Cancer. National Cancer Institute: Surveillance, Epidemiology, and End Results Program. https://seer.cancer.gov/statfacts/html/breast.html