Early detection and early treatment are the best ways to fight any cancer — and that can be especially true of breast cancer.
There are many tools for breast cancer diagnosis and the American Cancer Society recommends examinations should be tailored to the individual: An annual mammogram for normal-risk women over 40 or an annual mammogram and MRI for high-risk women starting at age 30.
But what’s been a subject of debate is whether it does harm or good for women to do their own breast self-examinations. Both the ACS and the American College of Obstetricians and Gynecologists have backed away from breast self-exams as a recommendation to diagnose breast cancer — because the average person may not know the difference between true breast cancer symptoms and other physical changes, which may not be cancer-related.
"It hasn't been shown to save lives, so it has fallen out of favor in recommending it as a screening tool," Dr. Deborah Axelrod, a surgeon who specializes in breast disease and cancer at NYU Langone Health's Perlmutter Cancer Center told TODAY.
The American College of Obstetricians and Gynecologists does not recommend breast self-exams, according to a statement provided to TODAY by Kate Connors, the organization's Interim Director of Media Relations and Communications.
"Breast self-examination is not recommended in average-risk women because there is a risk of harm from false-positive test results and a lack of evidence of benefit," said the statement. "In its 2009 breast cancer screening guidelines, the U.S. Preventive Services Task Force recommended against teaching breast self-examination (grade D recommendation) based on the lack of evidence regarding benefits and because of potential harms from false-positive findings."
But, there is a powerful reason that breast self-exams are still worth the time, according to Axelrod: It’s important for women to stay aware of their own breast areas, so that any concerning changes can be brought to a medical professional.
"First of all, it doesn't cost anything and it's convenient to do," Axelrod said. "But, I think it's helpful that every woman should really familiarize herself with what her breasts look like and what they feel like."
Young women should be particularly aware of their breasts, she added, since they are not typically recommended to have breast cancer screenings as often as older women — and that awareness can save lives.
"We're not really screening them in any effective way, unless they have a specific risk," Axelrod said. According to the statement from ACOG, approximately 71 percent of the cases of breast cancer in women younger than 50 years of age are detected by women themselves.
How to conduct a self-exam
The Centers for Disease Control and Prevention recommends women should begin by standing topless in front of a mirror and doing a visual inspection to confirm that there are no noticeable differences in the breasts, like puckering or changes in size, then find a methodical technique to make sure the whole breast area is examined.
Axelrod recommends using the pads of the fingers, avoiding pressing with fingernails, and applying different levels of pressure to see if the feeling or response is any different.
"Make sure that you're covering the entire area, because breasts really can extend from the clavicle to below the bra line and from the breastbone to the underarm," she explained. "It can encompass a wide area."
She also recommended finding a quiet moment in the day to do the breast exam. While examining, lie down and raise the arm of the breast being examined above the head and do the exam with the opposite hand.
"Do it on the first of the month, or whenever you pay your bills, or whenever is a consistent time to remember," Axelrod said.
"We have never proven that this saves lives. We've never shown that it is effective as a screening tool," she continued. "But if you have a young woman, where you're not doing anything — this is free, this is convenient, it doesn't cost anything. She might as well know that something could be different."
Women should conduct a self-exam every few months, Axelrod said.
What to be aware of
Make an appointment with a doctor if any of these signs are present, according to the Mayo Clinic:
- A hard lump or knot near the underarm
- Changes in the way breasts look or feel, including thickening or prominent fullness that is different from the surrounding tissue
- Dimples, puckers, bulges or ridges on the skin of the breast
- A recent change in a nipple to become pushed in (inverted) instead of sticking out
- Redness, warmth, swelling or pain
- Itching, scales, sores or rashes
- Bloody nipple discharge