When would be the best time during the month for a post menopausal woman to perform self-breast examination?



Performing routine breast self-examination is an important adjunct to annual screening mammography. BSE should be performed on a monthly basis by all women over 20 years of age. In women who are menstruating, the most appropriate time to perform BSE is immediately following the cessation of your menstrual cycle. For women who are post-menopausal or have had a hysterectomy, BSE should be performed on the same day of each month, for example, the fifteenth of each month.

1. In the shower or tub:

• Put one hand behind your head.
• With your fingers flat (do not use the fingertips), move your hand over the entire breast area.
• Use the right hand for the left breast, and vice versa.
• Examine the entire breast. You may work inward/outward in circles from the nipple region to the outer edge of the breasts, or examine each section of the breast in pie-shaped wedges.
• Check for lumps, knots or thickenings.

2. Before a mirror:

• With your hands at your sides, check for visible lumps or dimpling.
• Raise your arms above your head. Look for changes in the shape or size of your breasts as well as changes in the skin texture.

3. Lying down:

• Place a pillow or towel under your right shoulder and your right hand behind your head.
• Follow the same technique as in the shower. Remember to use the right hand for the left breast; left hand for right. Check for lumps, knots or thickenings.
• Examine every part of the breast area including the underarm. Repeat on the left.
• Lastly, gently squeeze the nipple of each breast, checking for any crust or discharge.

The American Cancer Society recommends beginning in their 20s, women should be told about the benefits and limitations of BSE. Women should be aware of how their breasts normally look and feel and should report any breast changes to a health professional as soon as they are found. Finding a breast change does not mean there is a cancer. Women can notice changes by being aware of how their breasts normally look and feel and by feeling their breasts for changes (breast awareness) or by choosing to use a step-by-step approach, using a specific schedule to examine her breasts (breast-self exam, or BSE)

Examining your breasts is an important way to find a breast cancer early, when it’s most likely to be cured. Not every cancer can be found this way, but it is a critical step you can and should take for yourself. No woman wants to do a breast self exam (or “BSE”), and for many the experience is frustrating-you may feel things but not know what they mean. However, the more you examine your breasts, the more you will learn about them and the easier it will become for you to tell if something unusual has occurred. BSE is an essential part of taking care of yourself and reducing your risk of breast cancer.

Regularly examining her own breasts allows a woman to become familiar with how her breasts normally look and feel and can help her more readily detect any changes that may occur. Many women naturally have some lumpiness and asymmetry (differences between the right and left breast). The key to the breast self-exam is to learn how to find changes in the breasts that persist over time. While most women are aware of monthly breast self-examination, many still do not know how to perform it properly. Performing BSE incorrectly can be almost as bad as not doing the exam at all since it can give women a false sense of security. Don’t panic if you think you feel a lump. Most women have some lumps or lumpy areas in their breasts all the time. Eight out of ten breast lumps that are removed are benign, non-cancerous.

Breast self-exams should be performed once each month beginning at age 20 and continue each month throughout a woman’s lifetime.

The Best Time to Perform Breast Self-Exam

Menstruating Women:

Hormonal changes due to the menstrual cycle may make the breasts more lumpy or swollen. Women who are menstruating should perform breast self-exam from a few days to about a week after menstruation (period) has ended, when breasts are usually less tender or swollen.

Women who are no longer menstruating:

They should do their BSE on the same day every month. Try to pick a day that is easy to remember, such as the first or fifteenth of every month, and make that the day each month for breast self-exam.

Women using oral contraceptives:

They are encouraged to do their BSE each month on the day they begin a new package of pills.

Step 1:
Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.

Here’s what you should look for: • Breasts that are their usual size, shape, and colour.

• Breasts that are evenly shaped without visible distortion or swelling.

If you see any of the following changes, bring them to your doctor’s attention: • nipple discharge • dimpling, puckering, or bulging of the skin. • a nipple that has changed position or an inverted nipple (pushed inward instead of sticking out).

• Redness, soreness, rash, or swelling.

Step 2:
Now, raise your arms and look for the same changes.

Step 3:
While looking at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge (this could be a milky or yellow fluid or blood).

Step 4: • Lie down and place your right arm behind your head. The exam is done while lying down, and not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and it 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 your left hand to feel for lumps in the right breast. Use overlapping circular motions of the finger pads to feel the breast tissue. • Be sure to feel all the breast tissue: just beneath your skin with a soft touch and down deeper with a firmer touch. Begin examining each area with a very soft touch, and then increase pressure so that you can feel the deeper tissue, down to your ribcage.

• Repeat the exam on your left breast, using the finger pads of the right hand.

Step 5:
Examine each underarm while sitting up or standing and with your 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 difficult to examine.

Women should know how their breasts normally look and feel. Doing regular breast self-exams is the best way to know this. They also help you to notice any changes in your breasts. A change can be a sign of a problem. If you find a change, see your doctors right away.

Most breast changes or lumps are not cancer, but only a doctor can tell for sure. When breast cancer is found early, you have more treatment choices and a better chance of recovery, so it is best to find breast cancer as early as possible.

Breast self-exams should not take the place of regular screening mammograms or clinical breast exams, which are done by a doctor. By doing routine breast self exams and having routine mammograms and checkups, you can help detect breast problems early.

Who Should Do a Breast Self Exam?

ALL women should do the BSE once a month. This also includes women who:

• Have gone through menopause
• Are pregnant
• Are breastfeeding
• Have breast implants

When To Do a Breast Self Exam?

Women should begin practicing breast self-exam by age 20, and continue the practice throughout their lives, even during pregnancy and after menopause.

Breast Self Exam (BSE) should be performed every month.

• If you still menstruate, the best time to do a BSE is a few days after your period ends, when your breasts are not tender or swollen.
• If you have gone through menopause, try to do the exam on the same day each month. Some women choose the first day of each month to help them remember.
• If you are taking hormones, talk to your doctors about when you should perform the BSE.

Mallory MA, Golshan M. Examination techniques: roles of the physician and patient in evaluating breast disease. In: Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 25.

Sandadi S, Rock DT, Orr JW, Valea FA. Breast disease: detection, management, and surveillance of breast disease. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 15.

Swartz MH, Nentin FG. The breast. In: Swartz MH, ed. Textbook of Physical Diagnosis: History and Examination. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 16.

Preventive Services Task Force website. Breast cancer: screening. www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening. Updated January 11, 2016. Accessed June 2, 2021.