Women are aware of the importance of mammograms as a breast cancer screening tool. Yet breast self-exams and regular clinical breast exams performed by a physician also are important components of preventive breast care.
“Breast self-exams should start for women in their 20s,” says Dr. Adriana Canas-Polesel with Mercy Clinic Women’s Health Fenton. “Although breast cancer is rare for women in this age group, the risk does increase with age. Women may notice changes in their breasts when self breast exams are done routinely in a systematic step-by-step approach to examining the look and feel of their breasts. The goal is to report any breast changes to their medical provider.”
Breast surgeon Dr. Stephanie Schnepp, medical director of SSM Breast Care at St. Mary’s Health Center, agrees: “Exam is still the way many breast lumps are detected. Mammograms are not perfect, and it is possible for there to be changes in the time frame between mammograms, so the combination of regular exams and mammograms is the best way to make sure any new lumps are found as early as possible.”
But what exactly are we feeling for? Physicians say that women should perform a monthly self-exam in order to become familiar with the topography of one’s own breasts. Lumps and bumps are common features of normal breast tissue or temporary changes due to hormonal fluctuations, but by performing exams on a regular basis, women learn what feels normal for their breasts and what does not.
Additional help and instruction is easily available. “We have instructional brochures on how to perform breast self-exam,” says Sarah Ernsky, manager of the Breast HealthCare Center at Missouri Baptist Medical Center. “If a woman has further questions, any of our technologists or nurses can teach someone how to perform a breast self-exam. We frequently are out in the community at health fairs or on our mobile mammography van educating women on breast self-exam.”
The best time to perform a self-exam is during the week following the menstrual period because hormonal changes just prior to and during menses can increase breast lumpiness. Clinical breast exams performed by a health-care provider are recommended every three years for women in their 20s and 30s and annually after age 40. The clinical exam typically is done during an annual well-woman exam.
The value of breast self-exams was questioned by the U.S. Preventive Services Task Force, which recommends against teaching breast self-examination (BSE) and states that “the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.”
However, most physicians still advise the practice. “I realize that it is being removed from some of the official recommendations. However, I do still see many women who find their own breast lumps,” Schnepp says. “While most lumps found on self-exams are not cancerous, a few are, and this may be the first way it is discovered. So my personal opinion is there is value in doing it.”
Schnepp adds that any concerns should be discussed with one’s primary-care physician. “You know yourself best. If you notice anything different on your own exam, tell your doctor.”