SHOULD WE BE PERFORMING SELF BREAST EXAMINATIONS?

Like many things to do with health and the human body, the evidence is muddy. 

 

WOMEN SHOULD NOT ROUTINELY PERFORM BREAST EXAMINATIONS  

An opinion article published in the Journal of Obstetrics and Gynaecology of Canada (1) recommends that breast self examination should not routinely be taught to women as they concluded there were risks of unnecessary biopsies being performed with no reduction in mortality rates. They drew their conclusions largely due to a gigantic randomised, longitudinal trial completed in Shanghai (2).

WOMEN SHOULD COMPLETE BREAST SELF-EXAMINATION

There is less robust evidence that supports breast self-examination. It suggests excellent physical examination practice, whether breast examination performed by a health professional or breast self-examination, may reduce mortality (3). 

I’m firmly in the camp of giving breast self examination a red hot go.  You might feel things but not know what they are and whether it’s normal but like all skills, the more you examine your breasts, the better you’ll get to know them and find any changes. 

IS THERE A PERFECT WAY TO DO A BREAST EXAMINATION?

Probably not.  

GET TO KNOW YOUR OWN BREASTS

What is important is to know the look and feel of your breasts’ various peculiarities. Has that blobby area changed from a few months ago?  Does something stand out as different from the rest (like a rock on a sandy beach)? 

A 2005 systematic review suggests women should look and feel their breasts and know what is normal.  They should also know what changes to look for and know what to do if a change is found (4).

This is a step by step taken from the USA breastcancer.org site, which is about as simple and as complex as you probably need to be.

YOU’LL NEED A MIRROR

STEP ONE: Look at the shape and appearance of your breasts and nipples in the mirror with your hands on your hips

STEP TWO: Raise your arms above your head and look at your breasts. Look for any changes in the shape of the breasts.

STEP THREE: Look at your nipples to see whether there is any fluid coming out.

STEP FOUR: Feel for lumps in the breasts either standing up or lying down.

STEP FIVE: Feel for lumps in the nipple area and in the armpits (5)

WHAT CHANGES AM I LOOKING FOR?

Armed with some knowledge of what is normal for you, detecting changes should be easier.

You’re on the lookout for:

  • New lumps
  • Thickening in breast tissue
  • Nipple sores
  • Nipple discharge
  • Nipples turning in
  • Skin dimpling
  • Rash
  • Red swollen breasts (6)

If you notice any changes report to a health professional IN A TIMELY MANNER. Rushing off every month will probably leave you and your GP frustrated. Equally, don’t wait just because you don’t want to bother anybody with your weeping, red nipple.

HOW OFTEN DO I NEED TO CHECK MY OWN BREASTS?

Tricky.  A slow progression may not be noticed if you undertake an examination every month.  However, if you don’t complete it often enough then you won’t know what normal is.  

An educated guess would be four times a year?

WHEN TO COMPLETE?

Choose a day that's easy to remember, such as the first or last day of the season.  If you are still having your period, complete the check a few days after your period has ended.

SHOULD I KEEP RECORDS?

Many people find keeping records onerous and it might stop you from even peering at your boobs in the mirror.  Another person might find it essential to set an alarm, and keep thorough notes on their phone.   

You can download this PDF sheet to track your attempts and any changes or you can download this app from the McGrath Foundation http://www.curvelurve.com.au/

WE SHOULD BE MORE CONFIDENT TO CHECK

Learning how to undertake a breast self-exam is the first step as we spend far more time with our breasts than anybody else.  

IF YOU’RE 50+

BreastScreen Victoria provides free mammograms to women over 50 as over 50% of women diagnosed with breast cancer are 50-69. 

References

(1) Journal Obstetrics and Gynaecology of Canada 2006; 28(8):728–730

(2) Thomas DB, Gao DL, Self SG, Allison CJ, Tao Y, Mahloch J, et al. Randomized trial of breast self-examination in Shanghai: methodology and preliminary results. J Natl Cancer Inst 1997;89:355–65

(3) Harris R, Kinsinger LS. Routinely teaching breast self-examination is dead. What does this mean? J Natl Cancer Inst 2002;94(19):1420–1.

(4) McCready, Littlewood, Jenkinson. Breast self examination and breast awareness: a literature review.  Journal of Clinical Nursing 2005 (14); 570-8.

(5) http://www.breastcancer.org/symptoms/testing/types/self_exam/bse_steps

(6) GETTING A GRIP A Report Into Breast Health Understanding Among Women In Australia Based on independent research carried out by AMR for the McGrath Foundation October 2016