Breast Self-Examination

Breast self-examination is a habit that helps make it easier to notice changes that may develop in the breast over time. The aim is to become familiar with the breast tissue and to recognize without delay when a new finding appears. This examination does not provide a diagnosis on its own; however, it may contribute to the early recognition of changes that should be considered in terms of breast cancer symptoms. In particular, signs such as a new palpable lump in the breast, a noticeable change in the shape of the breast, dimpling or thickening of the skin, nipple retraction, or unilateral discharge are among the findings that may be noticed during the examination.

For the examination to be more meaningful, it is important to perform it at regular intervals and under similar conditions. Breast tissue may feel different throughout the menstrual cycle due to hormonal effects. For this reason, determining the appropriate time for breast self-examination may reduce false alarms and help the person become more familiar with the normal structure of the breast. In the postmenopausal period, choosing a specific day and performing the examination at the same time every month may make follow-up easier.

Breast self-examination is not a practice that replaces screening methods such as mammography. Mammography is a method used for breast cancer screening and can show small changes that cannot be felt during examination. Manual examination should be seen as an awareness step that supports screening programs. When a new change is noticed during the examination, instead of just monitoring it, an appropriate imaging plan should be arranged with physician evaluation.

How Is Manual Examination Performed in Breast Cancer?

Manual examination is carried out in three steps: looking, touching, and nipple check. The aim is to examine the entire breast in the same order and to be able to compare under similar conditions every month.

1) Looking in the mirror (1-2 minutes)

In front of the mirror, the shape of the breasts and the skin are observed. With the arms at the sides, the symmetry of the breasts and whether there is any new dimpling in the skin are checked. The same inspection is repeated with the arms raised. The hands are pressed onto the waist and the chest muscles are tightened; it is checked whether there is skin retraction, a noticeable change in shape, or a difference on one side. This step helps identify skin changes that may not be noticed by touch.

2) Touching while standing (especially easier in the shower)

One hand is placed behind the head. The breast tissue is examined with the flat parts of the three middle fingers of the other hand. Pressure is not applied at a single level; the area is checked with light, medium, and slightly deeper pressure. This allows both the tissue close to the surface and the deeper tissue to be evaluated more effectively.

One method is chosen for scanning and applied the same way every month:

• Clock method: Starting from the nipple, all sections are checked in a clockwise direction.
• Strip method: The breast is scanned in vertical strips from the collarbone down to the fold under the breast.

3) Touching while lying down (makes it easier to feel clearly)

Lying on the back, a thin pillow is placed under the shoulder on the side to be examined, and the arm on the same side is raised above the head. Because this position spreads the breast tissue, small differences can be noticed more easily. The same scanning method used while standing (clock or strip) is repeated in the same order.

The armpit is also checked to see whether there is any new swelling or firmness.

4) Nipple check

It is checked whether there is nipple retraction, persistent crusting, a wound-like appearance, or spontaneous discharge. Discharge when the nipple is gently squeezed is not always meaningful; however, spontaneous unilateral discharge especially requires evaluation.

When Should Breast Manual Examination Be Performed?

For manual examination to be interpreted accurately, it is important to perform it during the period when the breast tissue is less affected by hormonal changes. Throughout the menstrual cycle, breast tissue may become tense, sensitivity may increase, and small irregularities may be felt more clearly. Because this may increase false alarms, it is beneficial to keep the timing of the examination consistent.

In menstruating individuals, the most suitable period is considered to be the 5-7 days following the end of menstrual bleeding. During these days, the breast is less swollen, making it easier to distinguish the natural structure of the tissue. In those with irregular menstruation, “the few days after the end of menstruation” may be used as a monthly reference; if this is not possible, choosing a fixed day of the month and performing the examination on that same day each month provides consistency.

In the postmenopausal period, since hormonal fluctuations are less pronounced, timing the examination is easier. Performing the examination on the same day every month helps monitor changes more clearly. Since the breast tissue may be fuller and more sensitive during the postpartum breastfeeding period, it is more appropriate to plan the examination for evaluation purposes and to seek medical advice without delay if a suspicious finding is noticed.

Which Findings Should Be Considered During Breast Examination?

The findings to watch for during manual examination are not limited to the question of “is there a lump.” Breast tissue may feel different throughout the month; therefore, what matters is the appearance of a new change or a noticeable alteration in a known area. Not every finding noticed during examination means cancer; however, some changes require physician evaluation.

First of all, a newly appearing firmness or lump that is more noticeable on one side and has palpable borders is important. In particular, formations that feel hard, have an irregular surface, feel fixed, or are thought to be enlarging over time should be evaluated. In addition, thickening in one part of the breast, a noticeable fullness difference compared with the other breast, or persistent sensitivity in a single area should not simply be ignored.

Skin-related changes may also provide critical clues. If skin dimpling, indentation in a specific area, an orange-peel appearance, persistent redness, or thickening in a particular area is noticed, evaluation is necessary. Newly developed nipple retraction, persistent crusting around the nipple, or a non-healing appearance should be taken seriously. Regarding discharge, spontaneous, unilateral, bloody, or clear discharge is considered more carefully.

Finally, the armpit is also part of the examination. Newly noticed swelling, firmness, or a palpable formation in the armpit may be related to causes other than the breast; however, it still requires evaluation.

Can Breast Cancer Be Detected by Manual Examination?

Manual examination is not a method that can definitively identify breast cancer. The examination helps notice a new change in the breast; however, in most cases it is not possible to distinguish by touch alone whether a finding is benign or a condition requiring further evaluation. This is because different conditions may feel similar. For example, benign cysts, formations such as fibroadenomas, or tissue density changes related to hormonal changes may also be palpable. Therefore, manual examination is not diagnostic, but rather a supportive step for awareness and early consultation.

Some findings that can be noticed by manual examination may strengthen the need for further evaluation. If there is gradually increasing firmness, asymmetry becoming more noticeable in a single area, skin dimpling, a new change in the nipple, or spontaneous unilateral discharge, physician evaluation should be sought without delay. Still, the presence of these findings does not by itself mean a breast cancer diagnosis. Likewise, not feeling any finding does not rule out breast cancer. Some changes may be too small to be detected by examination, or they may be harder to notice because the breast tissue is dense.

For this reason, the correct approach is to maintain manual examination as a regular habit and to complete the diagnostic process with imaging methods if a suspicious change is noticed. In this way, unnecessary concern is reduced while delays are also avoided in situations that carry real risk.

Can Manual Examination Replace Mammography?

Manual examination is not a method that replaces mammography. This is because mammography is a screening method that can show small changes and certain types of findings that may appear before they become palpable in the breast. Manual examination, on the other hand, mainly helps notice changes in the breast that can be felt. The functions of these two approaches are different, and one does not substitute for the other.

Especially when used for screening purposes, mammography can show small masses or certain types of calcifications that are difficult to notice during examination. Such findings may not be palpable during manual examination. In addition, in people with dense breast tissue, it may be more difficult to distinguish between “normal tissue” and “change” by touch. For this reason, in people who require a screening program, the mammography plan is evaluated as a separate issue even if manual examination is performed.

The contribution of manual examination is that it helps the person become familiar with their own breast tissue and notice a new finding without delay when it develops. In this way, earlier consultation may occur when imaging becomes necessary. The most appropriate approach is to maintain manual examination as a regular habit, not to neglect mammography in the age and risk groups that require screening, and to follow the imaging plan recommended by the physician in the presence of a suspicious finding.

What Should Be Done If a Change Is Noticed During Breast Examination?

When a new change is noticed during examination, the first step is to focus on clarifying what the finding is without panicking. This is because not every palpable finding in the breast means breast cancer. Still, it is not correct to wait a long time with the thought that it will “go away.” Evaluating the change within a short time both reduces unnecessary anxiety and prevents delay in situations that require follow-up.

First, if possible, the change may be confirmed not on the same day but by checking again a few days later. The reason is that temporary tenderness or fullness may occur in the breast due to hormonal effects such as the menstrual period. However, this repeat check should not be used to postpone consulting a physician. Especially if the firmness is pronounced, has newly appeared in one breast, or is accompanied by skin dimpling or a new change in the nipple, evaluation should not be delayed.

After consultation, the process usually proceeds with examination and an imaging plan. Depending on age and the structure of the breast tissue, breast ultrasound, mammography, or both together may be requested. If imaging suggests that the finding has benign features, follow-up may be recommended. In cases considered suspicious, a biopsy may come into consideration. The purpose of biopsy is to eliminate uncertainty and determine the correct management plan.

In the following situations, evaluation is necessary without waiting for the follow-up time:

• rapidly growing swelling in the breast,
• significant skin change,
• spontaneous unilateral discharge,
• new nipple retraction,
• new swelling in the armpit,
• fever
• pain together with redness.

Although these findings may occur for different reasons, they require early evaluation.

Frequently Asked Questions About Breast Self-Examination

Is Every Palpable Lump in the Breast Cancer?

No. A significant portion of palpable breast lumps may develop due to benign causes. Cysts, fibroadenomas, or areas of tissue density related to hormonal changes are examples of this. A reliable evaluation of the lump is made through examination and appropriate imaging. In cases where it is considered necessary, confirmation is achieved with a biopsy.

Why Are Nipple Discharge and Retraction Important?

Newly developed nipple retraction or spontaneous unilateral nipple discharge are among the findings that require evaluation. The color of the discharge, whether it occurs spontaneously, and whether it is unilateral are important. These findings do not always indicate a malignant condition; however, they should be clarified with imaging and physician evaluation.

When Should Breast Examination Be Performed After Menopause?

Since hormonal fluctuations are less pronounced after menopause, it is appropriate to choose the same day each month for the examination. This routine makes it easier to notice changes in the breast. If a new finding is noticed during the examination, evaluation should be sought without delay.

How Is Breast Examination Performed in Men?

Because breast tissue is less prominent in men, the examination is performed over a more limited area. The area around the nipple and the breast tissue are checked for firmness or a lump. Findings such as nipple discharge, skin dimpling, or unilateral enlargement around the nipple require evaluation. In addition, the armpit can also be checked for palpable swelling.

What Does Firmness Felt During Breast Self-Examination Mean?

A palpable firmness does not always mean breast cancer. Temporary tissue changes related to the menstrual period, cysts, or benign lumps may also create a feeling of firmness. However, if the firmness has newly appeared, has become more prominent in one breast, increases over time, or is accompanied by findings such as skin dimpling or changes in the nipple, evaluation is needed without delay. The most appropriate approach is to clarify the finding through physician evaluation and appropriate imaging after the examination.