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Breast awareness and self exam


Cathy Thoemmes, R.N.

We all know that October is Breast Cancer Awareness month. The pink ribbon is a universal symbol and reminds us that each of us has been affected on some level by this devastating disease. It is important to stress that early detection is key and is best achieved by a three step process:

1. Mammograms starting at age 40
2. Annual clinical breast exam performed by a physician
3. Monthly breast self-exams starting at the age 20

Breast Self-Exams (BSE)

A woman can notice changes by being aware of how her breasts normally look and feel and by feeling her breasts for changes (breast awareness). It is important to know what “normal” feels like so you can know when something has changed.  

Women with breast implants also can perform BSEs. It may be helpful to have the surgeon help identify the edges of the implant so you know what you are feeling. There is some thought that the implants push out the breast tissue and may actually make it easier to examine. Women who are pregnant or breastfeeding also should examine their breasts regularly.

How to examine your breasts:

Lying down:

• Lie down and place your right arm behind the head. The exam is done while lying down because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.

• Use the finger pads of the three middle fingers on the left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.

• Use three different levels of pressure to feel all the breast tissue; use each pressure level to feel the breast tissue before moving on to the next spot:
o Light pressure is needed to feel the tissue closest to the skin;
o Medium pressure to feel a little deeper;
o Firm pressure to feel the tissue closest to the chest and ribs.

• It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your physician if you feel anything out of the ordinary. If you're not sure how hard to press, talk with your physician or nurse.

• Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone. Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone. There is some evidence to suggest that the up-and-down pattern is the most effective pattern for covering the entire breast, without missing any breast tissue.

• Repeat the exam on the left breast, putting the left arm behind the head and using the finger pads of the right hand to do the exam.

Standing in front of a mirror:

• While standing in front of a mirror with hands pressing firmly down on the hips, look at the breasts for any changes of size, shape, contour or dimpling, and redness or scaliness of the nipple or skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)

• Examine each underarm with the arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

Attend a breast self-exam class

The Cancer Centers of Northern Arizona Healthcare (CCNAH) offer free one-hour breast self-exams. Silicone models are used as a teaching tool for women to have a “hands-on” experience in the class. Women come away from the class not only knowing how to detect an abnormality but also learn what “normal” feels like. It is important to know what you are feeling so that you can know when something has changed.

The classes are held the second and fourth Tuesday each month at the Breast Cancer Resource Center located at the CCNAH at Flagstaff Medical Center. To make an appointment, call 928 773-2261.

Cathy Thoemmes, R.N., is an oncology-certified and breast health nurse at the Cancer Centers of Northern Arizona Healthcare.



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