The recommendations for doing regular breast self-exams to screen for cancer might seem confusing.
Doctors once urged women to do the exams every month and use a certain screening technique. Today, doctors simply encourage women at average risk for cancer to be aware of breast changes and leave it up to individuals to figure out the best way to track breast health at home.
Why did that happen, and what should you do to stay healthy?
They’re important questions to answer, since breast cancer is the second most common cancer in the country, behind skin cancers. Breast cancer accounts for approximately 30% — or 1 in 3 — new cancers diagnosed in women each year. The American Cancer Society estimates that there will be more than 287,000 new cases of invasive breast cancer and more than 51,000 new cases of ductal carcinoma in situ in 2022, with diagnoses steadily increasing at a rate of 0.5% each year. Men, too, can face breast cancer risks, although the lifetime risk is 1 in 833 men compared to 1 in 8 women.
Fortunately, breast cancer death rates have decreased since 1989, due in part to awareness and early detection.
[See: Breast Cancer Nutrition Myths.]
Shift in Thinking
The medical community used to be all-in on breast self-exams. Doctors spent time instructing patients on a particular technique for the exams, and medical organizations sponsored self-exam education campaigns.
The thinking was that detecting cancer that originates in breast tissue as early as possible would:
— Lead to early diagnosis and treatment.
— Keep cancer from spreading to other parts of the body.
— Improve chances of survival.
But while some women did the breast self-exams, some didn’t. And for those who didn’t, guilt sometimes crept into the picture.
“There were a lot of women coming into the clinic, and when you’d ask if they were doing their exams, they’d cringe and say they weren’t doing the prescribed technique. There was a stigma,” says Dr. Therese Bevers, professor of Clinical Cancer Prevention and the medical director of the Cancer Prevention Center and prevention outreach programs at the University of Texas MD Anderson Cancer Center in Houston, Texas.
In the early 2000s, the thinking on breast self-exams started to change. It originated from a large randomized study published October 2, 2002, in the Journal of the National Cancer Institute, that found the exams didn’t reduce breast cancer deaths and potentially increased the risks of women having to undergo biopsies for lumps that turned out to be non-cancerous. Some observational studies came to similar conclusions.
These findings prompted medical organizations to stop recommending self-exams for women at average risk of developing breast cancer and to start endorsing a breast self-awareness concept. The concept is not formally recommended for men, although many doctors advise it.
[SEE: Breast Cancer Symptoms.]
No Right or Wrong Exams
The breast self-awareness concept doesn’t mean you can’t do a breast self-exam.
“With breast self-awareness, there are no strict guidelines on the technique you should use or how frequently you should check your breasts,” says Dr. Nita Landry, an OB/GYN who practices as a travel doctor in the U.S. “Instead, you focus on an overall awareness of how your breasts normally look and feel so you can easily notice if something changes.”
The approach makes more sense, Bevers says, since self-exams aren’t typically the way breast cancer is caught at home.
“In fact, the vast majority of breast masses and cancers are found through normal activities like showering, dressing or scratching,” Bevers explains.
The breast self-awareness approach also includes educating women about evidence-based strategies for reducing the risk of developing breast cancer. These prevention strategies include:
— Exercising regularly.
— Controlling weight.
— Taking the drug tamoxifen (Soltamox) in high-risk cases.
[SEE: 13 Tips for a Mammogram.]
How to Do a Breast Self-Exam
If you’d like to do a breast self-exam, the specific technique is up to you. For example, you can:
— Stand up or lie down to perform an exam.
— Go in the shower and soap up your breasts.
— Put your arm behind your head and use the pads of your fingers to feel for breast changes.
— Press harder or softer.
“It’s whatever you can do to best assess your breast in its entirety,” Bevers says. “Some women place their fingers on their breast and go around in circles. Some do spokes on a wheel — in and out, up and down.”.
Another way to examine your breasts is to take a good look at them in bright light. You can stand in front of a mirror to do this or just look down at your breasts.
[SEE: How Do I Read My Breast Cancer Biopsy Report?]
What Are You Looking for?
There’s no one change that signals breast cancer. It’s different for every woman. Breast changes can include anything that’s new or seems different to you, such as:
— A thickening of breast tissue.
— Redness of breast tissue.
— Dimpling on breast skin.
— Discharge at the nipple.
— Breast swelling.
— Unusual lumps in the breasts or under the arms.
“You may be having a symptom that isn’t on a list,” Bevers says. “If you do note a change or you just have a hunch, call your doctor.”
What If You Find Something New?
Pick up the phone as soon as possible and call your health care provider if something about your breasts seems new or different.
What will happen? Your doctor will probably want to see you right away for a physical exam and order 3-D mammogram and ultrasound.
If the findings of those tests are concerning, your doctor might:
— Order a biopsy (done by a radiologist) to get a tissue sample, and then advise you on the next step once the results come back.
— Send you to a general surgeon or a surgical oncologist before a biopsy is ordered. “The breast surgeon can look at the imaging results and advise the patient about the next steps. Maybe a biopsy won’t be necessary. If it is, the patient will know what to expect and won’t have to go through anxiety about next steps while waiting for the results,” says Dr. Yana Markidan, a gynecologist based in Princeton, New Jersey.
If Findings Aren’t Concerning
Findings aren’t always related to breast cancer.
“Most of the time, you’ll be told you have a benign breast cyst (a fluid-filled sac),” Landry says. “If you have a more suspicious spot, you may need to return in a few months for repeat imaging to see if a lump or cyst has grown or changed. Or you may need a biopsy.”
In the meantime, you’ll be able to go back to your previous breast self-awareness routine or start one if you hadn’t been practicing one. And with 50% to 70% of breast cancers detected by patients themselves, it may be something you want to consider.
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How to Do a Breast Cancer Self-Exam at Home originally appeared on usnews.com
