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“Breast self-exams are no longer recommended.”
When I saw this headline earlier this year, I thought it was a typo. As someone who discovered my own breast cancer lump, which turned out to be stage three cancer, I was surprised to learn that many health organizations such as the American Cancer Society and the National Cancer Institute do not recommend breast self-exams. And they haven’t had that for years.
So what happened?
Breast self-examination was developed in the 1950s as a convenient and inexpensive way for people to detect breast cancer early, when it is most treatable. But in the 2000s, research found that formal breast self-exams (raising your arms, lying down, making circular movements, etc.) may not reduce your risk of dying from breast cancer. A meta-analysis comparing women who performed routine breast self-exams with those who did not perform self-exams found that there was no difference in their breast cancer survival rates. But people who did self-exams had more false positives and nearly twice as many breast biopsies without cancer.
Read: What you need to know about a breast biopsy >>
Without data to show that breast self-exams can reduce the risk of dying from breast cancer—and the possibility of harm from unnecessary testing—breast self-exams are no longer recommended by most professional organizations and health care providers for people at average risk. (Average risk means you have no personal or family history or genetic mutation such as BRCA 1 or BRCA 2)
Larry Norton, MD, a breast cancer oncologist at Sloan Kettering Cancer Center, said the guidelines’ move away from formal breast self-exams doesn’t mean you should stop paying attention to your breasts. It’s called breast self-confidence.
What is Breast Confidence?
When it comes to breast self-awareness, it’s important that you know how your breasts look and feel so you can identify any changes. “Lack of awareness of what is healthy in your body can prevent you from recognizing something that isn’t quite right,” Norton said. “It’s very good to know that something is different in your body, and it’s very good if you find something else – no matter what it is – to draw attention to it.”
Unlike breast self-exams, there is no schedule or technique for breast self-exams – it’s basically a matter of using your eyes and hands to figure out what’s normal for you. Signs of breast cancer to look out for may include:
- lump
- pain
- Dimples in the skin
- Discharge or bleeding from the nipple
- Redness or warmth
- Swelling/size changes
Norton said changes in appearance and nipple discharge are more obvious, but it’s important to know how your breasts feel because you may be able to spot signs of breast cancer that your doctor or imaging wouldn’t have picked up. “If you touch your chest and feel an unusual hard spot or an unusual spot that hurts but didn’t hurt before — those are the things that are a little more subtle,” Norton said.
Timing and risks of breast self-examination
Although most healthcare providers prefer a breast self-exam to a formal breast self-exam, some people may still want to stick with the standard technique and routine. If you do breast self-exams, it’s best to do them three to five days after your period ends, when your breasts are less tender or lumpy. If you are postmenopausal, do the self-examination at the same time every month.
Read: How to do a breast self-exam >>
Risks associated with formal breast self-exams include false positive results and unnecessary biopsies of noncancerous tissue. Researchers say the mental and financial stress of imaging and biopsies is also part of the argument against formal breast self-exams. However, it is important to note that false positives are common and the likelihood of getting a false positive increases with age. Worry about false positives shouldn’t stop you from paying attention to your breast health and from contacting your doctor if you notice or feel anything unusual.
Norton said that during self-exams, it’s important to become familiar with your own breasts to notice any changes. But neither breast self-examination nor self-exams are a replacement for mammography when it comes to breast cancer screening.
Read: A mammogram saved my life >>
When should a mammogram be done?
Currently, mammograms are the gold standard for breast cancer screening. According to the latest guidelines from the US Preventive Services Task Force (USPSTF), people at average risk should start getting mammograms at age 40 – not at 50, as previously recommended. The change reflects recent data showing one in six new breast cancers occurs in people in their 40s and is in line with other organizations that offer screening guidelines.
Recommendations on how often one should undergo a screening vary from organization to organization, some say every year, others say every one to two years. You should talk to your doctor about what makes sense for your situation.
Regardless of the guidelines, Norton said if you feel or see anything suspicious, you should contact your doctor immediately. “I want to say that you are trusted with your body and you should do the things necessary to respect that trust – and one of them is getting checkups and another is just knowing your body. So if something is abnormal, don’t ignore it.”
This educational resource was created with support from Daiichi Sankyo and Merck.
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