You might not be a doctor, but you can recognize an abnormal lump by doing a breast self-exam — knowing the right clues to look for, of course. In honor of Breast Cancer Awareness month, let’s get to know our own breasts this October.
Not only does October raise much-needed recognition around breast health, it also encourages women to take control of their own health. A breast self-exam is one of the best ways women can optimize their health and lessen some of their anxiety around breast cancer. (As a physician, I never cease to be surprised by the number of women who pick up an abnormality on their own.)
Frequently examining your breasts is a great way to become familiar with what “normal” feels like to you. That way, if you ever feel something out of the ordinary you’ll know. And it’s important to keep in mind that not all lumps are breast cancer. In fact, the majority of breast lumps are not actually cancerous.
While many of us may know how to perform our own breast exams, we’re going to take it one step further by diving into when to do an examination and what, specifically, to examine for.
You got this.
First, Divide Your Breast Into Four Parts
Although cancerous lumps can occur anywhere in the breast, the most common location is the upper outer quadrant. (When describing what you feel, it helps to divide the breast into four sections: upper outer, upper inner, lower outer and lower inner.)
What to Feel and Look For
When performing a breast exam, look for the following seven characteristics:
- Size: Is the lump small or large?
- Texture: Is the lump hard or soft?
- Mobility: Is the lump fixed or mobile?
- Location: In which of the quadrants is the lump located?
- Pain: Is the lump painful?
- Nipple: Is there nipple discharge? If so, is it spontaneous or can you express any when you gently squeeze your nipple? What color is it? Is the nipple cracked or dry or reddened in any way?
- Skin: Are there any skin changes? Does the skin over the breast “dimple” (or indent) or in any other way look different?
Although it is impossible to say if a lump (or mass) is normal or abnormal (i.e., cancerous) just on physical examination, there are some clues, mostly related to the mobility of the lump and presence of pain. A fixed mass that's not moveable usually means it's not normal, and, surprisingly, a painful lump means it’s more likely to be normal.
Please note, however, that if you feel anything different at all, you owe it to yourself to seek immediate medical attention!
Click here to find a printable version of this chart.
What “Likely Normal” Feels and Looks Like
If the lump changes over the course of the month, as your cycle changes or just before your period starts, you may simply be feeling an increase in the normal nodularity (bumpy or increased density) of your breast tissue. Breast tissue changes in response to hormonal fluctuations during your cycle.
A mass with well-defined borders may be a cyst.
Benign breast lumps are often freely mobile. Cysts — usually just benign fluid-filled lumps — almost feel grape-like or even like a marble.
Breast pain can occur during a regular hormonal cycle or may be due to increased caffeine consumption or physical activity without a supportive bra. Everyone describes pain differently (sharp, dull, stabbing, etc).
Pay attention to whether the pain is in one breast only (if it’s in one breast it may be a cyst) or if it’s in both (pain in both may be do to an injury from not wearing a sports bra during your latest workout). Or notice if the pain changes with your cycle, which means it could be related to hormones. And remember, most pain is not associated with breast cancer!
What “Possibly Abnormal” Feels and Looks Like
A mass without clear borders may not just be a cyst. Sometimes it’s harder with abnormal lumps to feel a clear demarcation, especially if they are fixed to either the chest wall or a muscle, for example.
Abnormal breast lumps are often fixed and difficult to move, either because they are attached to the chest wall, an underlying muscle or even the skin. A solid lump may feel like a dried bean.
Often both breast cysts and breast cancer lumps are completely painless.
Nipple Discharge and Skin Changes:
New nipple discharge, the nipple being suddenly pulled inward (inversion) or changes in the skin over the lump all suggest that the lump may be abnormal and needs to be evaluated by a physician.
2 Ways & 3 Places to Perform a Breast Exam
There are two common ways to examine your breasts. For both, start by visually inspecting your breasts in front of a mirror, then either finish the examination lying down or in the shower. It doesn’t matter which one you choose, as long as you choose one and do it!
I tend to recommend sticking with one method so that you are consistent and remember each month to do so, but as long as you examine your breasts with some regularity, it doesn’t matter which method you choose.
A couple of key points to remember, whichever method you choose: On both breasts, examine your breast tissue in all four quadrants, which includes your armpits (you can consider this part of the upper outer quadrant, but specify “armpit” as the location to your physician if you find something there).
In front of a mirror: Begin by visually examining your breasts in the mirror — first with your arms at your sides, then with your arms raised up overhead. Before you actually examine each breast individually, place your hands on your hips, pull your chest back and push your arms forward a bit: Does either breast look different now?
Spend time looking at each breast separately. Does the skin on either breast look different? Does one side appear larger or smaller? Can you actually see a lump?
Lying down: Examine one breast at a time. To do so, place one arm behind your head and use the opposite hand to examine your breast in a circular motion with the pads of your fingers, starting on the outside and working toward the nipple.
When you get there, squeeze the nipple gently to check for any discharge. Repeat on the other side. Alternatively, you can examine each breast from top to bottom and left to right. Regardless, be sure to also feel under all of each armpit as well.
In the shower: Examine one breast at a time in a circular motion with the pads of your fingers, starting on the outside of the breast and working toward the nipple. When you get there, squeeze the nipple gently to check for any discharge. Repeat on the other side.
Alternatively, you can examine each breast from top to bottom and left to right. Regardless, be sure to also feel under all of each armpit as well. (I promise that is the last time I’ll state that.)
Through these practices, you will get indicators of whether or not you need to notify your physician.
The Best Time to Examine
As mentioned earlier, I recommend that you pick the same time of the month every month to examine your breasts.
While you are still getting periods, your breast tissue is responsive to the hormonal fluctuations that occur throughout your monthly cycle and this may affect what you are feeling.
In particular, in the days leading up to your period, your breasts may be more nodular, so I don’t recommend doing an examination at this time. I recommend waiting until you are mid-cycle. Once you’ve gone through menopause, then I recommend that you pick one day and stick with it each month (e.g., the first day of the month or perhaps your birth date).