Breast self-exam (BSE) is a tool that may help you become familiar with the way your breasts normally look and feel. BSE may help you find tumors in the time between your yearly mammogram and/or clinical breast exam. It may also help you see or feel changes in your breasts that should be reported to your health care provider. If you notice any of the warning signs of breast cancer listed below, see your health care provider right away.

• Lump, hard knot or thickening
• Swelling, warmth, redness or darkening
• Change in the size or shape of the breast
• Dimpling or puckering of the skin
• Itchy, scaly sore or rash on the nipple
• Pulling in of your nipple or other parts of the breast
• Nipple discharge that starts suddenly
• New pain in one spot that doesn’t go away

Adapted from National Cancer Institute [39-40], American Cancer Society [41], and Centers for Disease Control and Prevention [42].

Many women may find that their breasts feel lumpy. Breast tissue naturally has a bumpy texture. There is also a great deal of individual variation. For some women, the lumpiness is more pronounced than for others. In most cases, this lumpiness is no cause to worry. If the lumpiness can be felt throughout the breast and feels like your other breast, then it is probably just normal breast tissue. Lumps that feel harder or different from the rest of the breast tissue (or the tissue of the other breast) or that feel like a change are a concern. When this type of lump is found, there is more risk that it may be breast cancer. Some benign breast conditions though (such as cysts and fibroadenomas)can cause similar changes. (Learn more about benign breast conditions). See your health care provider right away if:

• You find a new lump or change that feels different from the rest of your breast.
• You find a new lump or change that feels different from your other breast.
• Feel something that is different from what you felt before.

If you are unsure whether you should have a lump checked, it is best to see your provider right away. Although a lump may be nothing to worry about, you will have the peace of mind that it has been checked.

Nipple discharge

Liquid leaking from your nipple (nipple discharge) can be troubling, but it is rarely a sign of cancer. Discharge can be your body's natural reaction when the nipple is squeezed. However, if discharge occurs without squeezing the nipple, occurs in only one breast or has any blood in it or is clear (not milky), a more serious condition, such as breast cancer, may be present. Nipple discharge can also be caused by an infection or another condition that needs medical treatment. For these reasons, if you have any nipple discharge, you should see your health care provider.

Breast cancer screening recommendations

Figure 3.1 shows the breast cancer screening recommendations of several major health organizations.

Learning how to do breast self-exam

Women who choose to do breast self-exam should learn how to do so correctly. To find out how to do breast self-exam, ask a health care provider, call our breast care helpline at 1-877 GO KOMEN (1-877-465-6636) or follow our step-by step instructions.

What's the evidence for breast self-exam?

Breast self-exam seemed promising when it was first introduced, and it has been widely advocated. However, the evidence that it provides a benefit is not conclusive [43]. Results of studies on its effectiveness at finding early stage tumors and improving chances for survival have been mixed through the years. Some studies supported its value and others did not [16]. A meta-analysis combined results from the two largest randomized controlled trials on breast self-exam to date (one in Shanghai, China and one in Russia). The Shanghai study included about 266,000 women and the Russia study included about 122,000 women. The combined analysis found no difference in breast cancer mortality after 15 years between women who did regular breast self-exam and women who did not [44]. And, the breast self-exam groups had nearly twice as many biopsies with benign results as the other groups [44]. Therefore, breast self-exam caused many women to have follow-up biopsies. These studies show that breast self-exam does not offer the benefits of other breast cancer screening tests.

Breast self-exam does give women a chance to become more aware of their own bodies and play active roles in their health. Breast self-exam can help you learn what your breasts feel like so that you can notice a change. If you do breast self-exam, you should be sure to also get recommended mammograms and clinical breast exams as directed by your health care provider. Breast self-exam should not be substituted for these other screening tests.

Updated 11/23/09

Clinical Breast Exam

Breast Cancer Screening Recommendations