What are the normal findings when doing SBE?
(Applicable to females)

Natural Conditions

When examining yourself, you may find things that cause you concern. When doing SBE, it's important to remember that each woman's breasts are different, and that changes can occur because of aging, the menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones.

It is normal for the breasts to feel a little lumpy and uneven. Also, it is common for a woman's breasts to be swollen and tender right before or during her menstrual period. 

Some of these are normal findings:

1.Bulge of tissue in the axillary tail (that portion of the breast extending into the armpit area)

2.Pad of slightly thicker tissue in the superior aspect of the breast

3.Hollow spot under the nipple (and sometimes a ridge as a result of this hollow area)

4.Ridge of firm tissue under the breast

5.“knobs” where the ribs join the breast bone. These are found about 1-2 inches away from the midline of your sternum (breast bone). 

For those who have had treatment for breast cancer

The surgery, radiation may leave your breast feeling different. There may be some permanent “swelling” or loss of sensation after radiation. The skin may be thickened. You should ask your doctor exactly how you should feel your breast whenever in doubt. 

What findings should alert us?

1.A change in the size or shape of the breast that is not explainable by weight loss or gain

2.A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly)

3.Ridges or pitting/dimpling of the breast (the skin looks like the skin of an orange)

4.Lump or thickening (look right into armpit, collar bone)

5.Nipple discharge or inversion (pulled back/indrawn), disappearance, rashes

6.Veins standing out more than is usual for you 

If you think you’ve found something unusual…

If you discover a lump in one breast, check the other breast. Check the same part of the other breast. If both breasts feel the same, the lumpiness is probably normal. You should, however, mention it to your healthcare provider or doctor at your next visit. 

If the lump is something new and is not thickened tissue or unusual and does not go away after your next menstrual period, it is time to pay a visit to your doctor. Make a note of where the lump or change is.  You can draw it into your diary or calendar where you record your SBE and first days of your menstrual cycle (menses). 

If you think you cannot remember any new “changes” for comparison the next month, you can make notes and draw it on a diagram for each month. This way, you can be more objective. However, remember that the position changes when you are in lying down and in sitting/standing position. 

This is an example of a diagram you can use. Just think of your breast like a clock face and the nipple is the centre. By noting your changes on the diagram or by using the “clock face method”, e.g. Left breast, 3 o’clock, 4 cm (distance) from the nipple, you can actually plot the “change” you feel (Ë).   

In the meantime, try not to keep feeling the lump many times a day. The same is true if you discover a discharge from the nipple or skin changes such as dimpling or puckering. Nipple discharge that is associated with a breast lump, is bloody, spontaneous and discharging only from a single duct may be more significant. Milky, clear, even greenish or yellowish discharges in multiple ducts or from both breasts are usually no cause for concern. 

Recurrent red, scaly patches in and around the nipple may be due to eczema and can be confused with the rash seen in Paget’s disease (associated with breast cancer). The best thing to do is to consult your doctor.

You should not let fear delay you. It is natural to be concerned if you find a lump in your breast.  

Remember that although 9 out of 10 lumps are benign, further examination and investigations are imperative. Do not let fear paralyse you. The sooner any problem is diagnosed, the sooner you can have it treated. It is far better to see the doctor and to set your mind at rest then agonise and hope it will go away.

CONSULT YOUR DOCTOR!

An idea of average lump size discovered when there is regular SBE compared to other situations:

How often should I do SBE?

SBE once a month is enough. Regular examination is necessary to get to know your breast and makes it easy to spot changes. Examine at the same time each month and this is normally after your menses (period) is over. Studies have shown that too frequent SBE may be unwise! 

For the first time, you may wish, out of curiosity to see the changes the breast undergoes in a month. However, after this, it is best to do it once a month.
 

Examining your breast more often than once a month may be counter productive. Why?

1.You may start to shorten the process (take short cuts) by doing cursory examinations in place of thorough and effective ones

2.Changes are more difficult to notice because you are feeling and looking at it daily

3.Changes are to be expected if you have your normal monthly menstrual cycles and hormonal fluctuations. This will increase the likelihood of mistaking normal cyclical changes as abnormal, especially in the build up to menstruation where the breasts become more lumpy and swollen.

4.You want to feel your breast when the breast is no longer “swollen” and sort of “settled’ down.

5.You want to feel your breast at the same state in relation to the hormonal influence so that comparisons can be made. 

Studies have shown that women examining their breasts too frequently (daily or weekly) may be doing themselves a disservice similar to those women who do not regularly examine their breasts. Dr Kate Brain found that 18% of study subjects who had a family history of breast cancer examined themselves too frequently because of anxiety of developing breast cancer. Excessive SBE makes early detection of breast cancer symptoms more difficult for the reasons mentioned earlier.
 

Bye Bye to SBE or finding the right balance? 

This focus on SBE would be incomplete without mentioning the rather controversial recommendation of the Canadian Task Force in an article published in the June 26, 2001 issue of the Canadian Medical Association Journal. The Task Force has recommended doctors to stop teaching SBE to women 40-60 years old. Their recommendation was based on data from several studies, including two large trials in China and Russia comparing women who conduct regular SBE with those who do not. Their conclusion was that there was probably no benefit but instead generation of unnecessary worry, fear and even depression amongst women with false-positive lumps (thought to be cancer but turned out to be benign conditions) who visit their doctors, may undergo biopsies only to find out that the lump was benign.

However, the American Cancer Society feels this is over interpreting the data from the studies. The fact is, many women are willing to accept the “false positives” and biopsies in the hope that early detection will save their lives. Secondly, the findings in China and Russia may not be application to the women in America or even Canada.

We have to acknowledge the fact that the majority of breast lesions are discovered by women themselves and is the only tool that brings women to their doctors, especially in the younger age group where screening mammography is not an option yet.

Some women already may never examine themselves because they do not want to find any cancer. Preoccupation with breast cancer is unhealthy. A delicate balance is necessary for managing anxiety and maintaining optimal adherence to SBE. Personal instruction in appropriate SBE technique and focus on reducing anxiety and improving proficiency is probably a better bet than completely throwing SBE out of the window!
 

Make Self Breast Examinations a regular part of
your life!

If you are still menstruating, do your SBE 2-3 days after your menses(period) is over.

If you are menopaused or a male, you can choose the first day of the month for SBE.