Making Sense of Breast 'Self-Exams'

October’s in full swing, and you can’t miss the pink (pink football cleats, pink tractors, even pink firefighters). Everyone is talking – rather candidly – about the importance of good breast health.

But for all this conversation, confusion persists. What constitutes a thorough “self-exam,” and how often do you conduct one? And if you’re vigilant about these self-checks, do you really need to bother with a regular mammogram? Are they (literally) more pain than they’re worth?

Cutting right to the point, Dr. Avice O’Connell, director of Women’s Imaging Services at URMC (including Highland Breast Imaging), gives straight answers below. If you’re a woman – or you love one – do yourself a favor and read on.

Scripts: When doctors ask women if they do regular self-exams, they might hesitate. What qualifies for an exam? And how often should women conduct them?

O’Connell: Let me start by saying I really hate the term “self-exam,” because it’s far too formal. It’s intimidating. It sounds complicated.

What we’re really advocating is for women to have a greater level of “self-awareness” – the same way a person might notice a new or changing freckle or mole. You have to know what’s normal for you, what your breasts typically feel like, so you can notice a thickening or a lump, should one develop.

That said, there’s no right or wrong way to be self-aware. It might be helpful to do a quick check once or twice a month, in the shower (maybe while waiting for your conditioner to soak in), or while getting undressed for bed. Be sure to watch for nipple discharge, red scaly patches, changes in size or shape, dimpling, lumps – really, anything that’s not normal for you. Just be sure you don’t do it immediately before your period, when hormones are peaking, and breasts are likely sore and sometimes swollen. And don’t be obsessive about it – daily checks might make actually make it more difficult to notice gradual changes in breast tissue.

Scripts: What should you do if you notice something worrisome?

O’Connell: Peace of mind is important, so don’t wait. Call your physician, and tell them your concern. If you’re under 30, they’ll likely send you for an ultrasound. If you’re older, you might receive a mammogram, too.

Many times, women put off these appointments, because they’re afraid they’ll be embarrassed if it turns out to be nothing worrisome. I tell them that that’s foolish; if anything, they should be proud to get a clean bill of health! They’re being prudent, not paranoid. It could be a cyst or a benign tumor or even normal tissue, but if it’s cancerous, time is of the essence. Their quick action is commendable. Women are the backbones of so many families; they need to be taking care of themselves so they can be around to take care of the so many others who depend on them.

Scripts: That’s a good way to look at it. Who needs an annual mammogram? There’s been a lot of confusing debate recently about when to start.

O’Connell: I’ll make it simple. If you’re over 40, and it’s been 365 days since your last mammogram, you need one. If you have a first-degree relative (mom, sister) who had breast or ovarian cancer, or if you’ve even been treated for Hodgkin’s lymphoma, you’re at heightened risk, and your provider might recommend starting younger.

Since the early 90s, when mammograms became routine, breast cancer death rates have dropped 30 percent. Certainly, that’s in part to credit to our better treatments. But you can only avail yourself of this improved medicine if you detect the cancer. Finding tumors while they’re still small (mammograms find tumors at early stages) increases your chances of beating cancer. Women who present with lumps they feel (usually at least the size of a grape or a walnut) may have more advanced disease and need more aggressive therapy.

Scripts: I’ve never had the dreaded mammogram. What can I expect?

O’Connell: First, it only takes 15 to 20 minutes – roughly the time it takes to style your hair! And the pain isn’t as bad as you might think; in fact, women who’ve had Botox, tattoos, body waxing say it doesn’t even rate with those voluntary beauty procedures. Most patients who come in nervous wind up saying “that wasn’t so bad” when they leave. You have to remember that it’s in the technician’s best interest to make sure you’re as comfortable as possible during the exam; they’ll really work with you to walk the fine line between compressing your breasts tightly enough to get a good picture, but not so tightly that you never come back!

Out of every ten women who report for routine mammograms, one will get a call back from doctors wanting to take another look or an ultrasound. One out of 50 (again, of those original mammograms presenting with no symptoms) might get a needle biopsy. Only five per 1,000 (again, of routine screening mammograms) might have a biopsies that reveals cancer. If you present with a lump, of course, the statistics are different. The important piece to remember is that the average woman has a one in eight risk of developing breast cancer at some point in her life. If you’re younger, cancers are likely more aggressive, since hormones might promote tumor growth. And again, a tumor you can touch and feel might be more advanced – and a bigger threat – than one detected by imaging alone. Getting mammograms gives you the best chance of finding them while they’re most beatable. You can’t be too careful.

One final point: Some women ask about compound radiation risk from annual appointments. You can rest assured that we’ve yet to see someone develop a cancer from routine screening. It’s a very negligible dose. Remember, mammograms find cancers; they don’t cause them!

To learn more about the comprehensive breast health services available at URMC, visit mammo.urmc.com.

Ready to make your appointment? Call 585-487-3300, or send an e-mail  to University Breast Imaging detailing the best times for you, and a representative will call you back. We have plenty of convenient locations to serve you.

Avice O’Connell, M.D., has practiced radiology for over 30 years in Rochester, New York. As the Director of Women’s Imaging, she brings her expertise to the Highland Breast Imaging Center and Department of Imaging Sciences at URMC.

To learn more about good breast health and protective breast screening exams, watch Dr. O’Connell in this video clip, produced by URMC-based Peri-FACTS Academy, a multimedia continuing education program for OB/GYN healthcare providers.