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“Breast self-exams are no longer recommended.”
When I saw that headline earlier this year, I thought it was a typo. As someone who found my own breast cancer lump that turned out to be stage 3 cancer, I was surprised to learn that many health organizations like the American Cancer Society and National Cancer Institute don’t recommend breast self-exams. And they haven’t for years.
So what happened?
The breast self-exam was created in the 1950s as a convenient and low-cost way for people to catch breast cancer early, when it’s most treatable. But in the 2000s, research found that doing formal breast self-exams (raising your arms, lying down, circular motions, etc.) may not reduce your risk of dying from breast cancer. One meta-analysis comparing women who did routine breast self-exams to those who did not do self-exams found that there was no difference in their breast cancer survival rates. But people who performed self-exams had more false positives and nearly twice as many breast biopsies with no cancer.
Read: What You Need to Know About a Breast Biopsy >>
Without data to show that breast self-exams can decrease the risk of dying from breast cancer — and the possibility of harm from unnecessary testing — breast self-exams are no longer recommended for people of average risk by most professional organizations and healthcare providers. (Average risk means you have no personal or family history or genetic mutation, like BRCA 1 or BRCA 2)
Larry Norton, M.D., a breast medical oncologist at Sloan Kettering Cancer Center, said the guideline shift away from formal breast self-exams doesn’t mean you should stop paying attention to your breasts. It’s called breast self-awareness.
What is breast self-awareness?
Breast self-awareness is being familiar with how your breasts look and feel so you can identify any changes. “The lack of awareness of what’s healthy in your body can inhibit you from identifying something that’s not quite right,” Norton said. “It’s very good to know there’s something different in your body, and it’s very good when you find something different — no matter what that is — to call attention to it.”
Unlike breast self-exams, there’s no timeline or technique to breast self-awareness — it’s basically using your eyes and hands to know what’s normal for you. Signs of breast cancer to look for can include:
- Lumps
- Pain
- Dimples in the skin
- Discharge or bleeding from the nipple
- Redness or warmth
- Swelling/changes in size
Norton said changes in appearance and nipple discharge are more obvious, but knowing how your breasts feel is important because you may be able to pick up on signs of breast cancer that your provider or imaging didn’t catch. “When you touch your breast, and you feel an unusual hard place or an unusual place that hurts but didn’t hurt before — those are the things that are a little bit more subtle,” Norton said.
Breast self-exam timing and risks
Although most healthcare providers recommend breast self-awareness over formal breast self-exams, 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 sensitive or lumpy. If you’re postmenopausal, do the self-exam at the same time each month.
Read: How to Do a Breast Self-Exam >>
The risks associated with formal breast self-exams include false positives and unnecessary biopsies of tissue that’s non-cancerous. Researchers say the mental and financial stress of imaging and biopsies is also part of the reasoning against formal breast self-exams. However, it’s important to note that false-positive results are common, and the chances of getting a false-positive result increase as you age. Concern about false positives shouldn’t stop you from paying attention to your breast health and contacting your healthcare provider if you see or feel anything unusual to you.
Norton said being familiar with your breasts in order to notice changes is the takeaway for self-exams. But neither breast self-awareness nor self-exams are a replacement for mammograms when it comes to screening for breast cancer.
Read: A Mammogram Saved My Life >>
When to get a mammogram
Right now, mammograms are the gold standard for breast cancer screening. According to the latest guidelines from the U.S. Preventive Services Task Force (USPSTF), people who are at average risk should start getting mammograms at age 40 — not 50 as previously recommended. The change reflects the recent data showing that 1 out of 6 new breast cancers develop in people in their 40s, and it aligns with other organizations that offer screening guidelines.
The recommendations for how often to get screened vary from organization to organization, with some saying every year to others saying every one to two years. You should talk to your healthcare provider about what makes sense for your circumstances.
Regardless of guidelines, Norton said if you feel or see something suspicious, contact your healthcare provider right away. “I like to say your body is entrusted to you, and you should do the things that are necessary to honor that trust — and one of them is screening tests and another is just knowing your body. So when something is abnormal, you don’t ignore it.”
This educational resource was created with support from Daiichi Sankyo and Merck.
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