What is breast self-examination (BSE)?

Cancers diagnosed:
Breast cancer

Why performed: Breast self-examinations are performed by women on their own breasts to detect unusual swellings, lumps, thickenings, or other conditions that may suggest the possibility of a breast disorder, including breast cancer. It is believed that this examination can educate a woman about how her breasts feel normally and, if performed routinely, alert her to any sudden changes, thereby facilitating early detection of a precancerous or cancerous mass. Proponents of formal BSE recommend that it be performed every month at the same time (in relation to the menstrual cycle).

Patient preparation: It is recommended that the examination take place in the shower (where water smooths the skin and makes it easier to detect changes) or lying prone.

Steps of the procedure: Using the left hand to examine the right breast (and vice versa), the woman should, with fingers flat, move gently over every part of the breast in a systematic fashion (vertically up to down or circularly from well beyond the exterior margins inward), starting well above the top margin of the breast and beyond each right and left margin as well. The examination should be conducted three times using light, medium, and heavy pressure. Women should also visually inspect their breasts from all sides. Muscles should be both flexed and relaxed. Women should be particularly alert to any swellings, dimpling of the skin, “orange-peel” (peau d’orange) appearance, discoloration, changes in or discharges from the nipple, lumps no matter how small, or other unfamiliar signs.

After the procedure: If a woman detects a change in how her breasts or nipples feel, then she should promptly notify her health care provider for follow-up. Diagnostic tests such as ultrasounds and biopsies may be conducted.

Risks: The examination can lead to anxiety in some individuals and often gives false-positive results.

Results: Women who perform a self-exam may become familiar with their own breasts and may be able to report abnormalities much earlier than if they wait for an annual clinical examination or mammogram. However, the USPSTF reported in its 2009 recommendation statement that self-exams have an accuracy sensitivity of only 12 to 41 percent as compared to 40 to 69 percent when performed by a medical professional. Early detection of precancerous or cancerous tissue greatly increases not only early treatment but also survival rates; thus, routine clinical examinations, irrespective of self-examinations, are very valuable screening tools.

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Kösters, Jan Peters, and Peter C. Gøtzsche. "Regular Self-Examination or Clinical Examination for Early Detection of Breast Cancer (Review)." Cochrane Database Systematic Review 3 (2008): 1–20. PDF file.

"Screening for Breast Cancer: Recommendation Statement." US Preventive Services Task Force. US Preventive Services Task Force, Dec. 2009. Web. 9 Sept. 2014.