American Cancer Association
Guidelines for Breast Cancer Detection

	Breast Self Examination:      Age 20 and over : Monthly
	Clinical Breast Examination:      Age 20-39 : Every 3 years      Age 40 and over : Yearly
	Mammography:      Age 40-49 : Every 1-2 years      Age 50 and over : Yearly

Breast Self Examination

All women over the age of 20 should practice regular monthly self breast examinations. The importance of this can not be over emphasized since an early cancer can be discovered by this method when mammography is normal. The examination should be done when the breasts are least tender, usually 7 days after the start of menstrual period. If a women detects any changes or lumps, she should seek medical attention. Remember that 9 out of 10 women will not develop breast cancer and most breast changes are not cancerous.

Breast Self Examination Techniques:

Remember the seven P's for a complete Breast Self Examination

	Positions
	Perimeter
	Palpation
	Pressure
	Pattern
	Practice with feedback
	Plan of Action

Positions

While standing in front of a mirror, visually inspect your breasts looking for changes in contour and shape, color and texture of the skin and nipple and evidence of discharge from the nipples.

This inspection should be done in 4 positions:

      Arms relaxed at sides
      Hands on hips
      Arms raised above the head and
      Bending forward

Palpation: Side-lying and Flat

Two palpation positions are employed, the side-lying and flat. Use your left hand to palpate your right breast, while holding your right arm at a right angle to the rib cage, with the elbow bent. Repeat the procedure on the other side.

The side lying position: lie on the opposite side of the breast to be examined.Rotate the shoulder on the same side of the breast to be examined back to the flat surface. The side lying position enables large breasted women to most effectively examine the outer portion of the breast.

For the flat position, lie flat on your back with a pillow or folded towel under the shoulder of the breast to be examined.

Perimeter

The examination area is bounded by a line which extends down from the middleof the armpit to just beneath the breast , continues across along the underside of the breast to the middle of the breast bone then up to and along the collar bone and back to the middle of the armpit. Most breast cancers occur in the upper outer area of the breast (shaded area in the image to the right).

Palpation with the Pads of the Fingers

Use the pads of 3 or 4 fingers to examine every inch of your breast tissue. Move your fingers in circles about the size of a dime.

Pressure

Use varying levels of pressure for each palpation, from light to deep to examine the full thickness of your breast tissue. Using pressure will not injure the breast.

Pattern of Search

Use one of the following search patterns to examine all of the breast and armpit. Palpate carefully beneath the nipple. Any incision should also be carefully examined from end to end. Women who have had any breast surgery should still examine the entire area and the incision.

Vertical Strip:
Start in the armpit, proceed downward to the lower boundary. Move a finger's width toward the middle and continue toward the middle and continue palpating upward until you reach the collarbone. Repeat this until you have covered all the breast tissue. Make at least 6 strips before the nipple and four strips after the nipple. You may need between 10 and 16 strips.

Wedge:
Imagine your breast divided like the spokes of a wheel with the nipple in the center. Examine each segment, moving from the outside boundary toward the nipple. Slide fingers back to the boundary, move over a finger's width and repeat this procedure until you have covered all breast tissue. You may need between 10 and 16 segments.

Circle:
Imagine your breast as the face of a clock. Start at 12 o'clock and palpate along the boundary of each circle until you return to your starting point. The move down a finger's width and continue palpating in ever smaller circle until you reach the nipple. Depending on the size of your breast, you may need 8 to 10 circles.

Check for Nipple Discharge:

Squeeze your nipples to check for discharge. Many women have a normal discharge.

Axillary Examination:

Examine the breast tissue that extends into your armpit while your arm is relaxed at your side.

Practice with Feedback

It is important that you perform Breast Self Examinations while your instructor watches to make sure that you are doing it correctly. Practice your skills under supervision until you feel comfortable and confident.

Plan of Action

Every women should have a personal breast health plan of action:

	Discuss the American Cancer Society breast cancer detection guidelines with your health care professional.
	Schedule your clinical breast examination and mammogram as appropriate.
	Do monthly Breast Self Examinations. Ask your health professional for feed back on your exam skills.
	Report any changes to your health care professional.

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