Mar 282011

Today’s post is a first in a series on prevention. Let’s start with self-examinations – specifically, breast self-exams (BSEs).

Benefits/limitations of BSEs:

  • They are optional (unless your doctor says otherwise) for detecting breast cancer. Some recent meta-analyses have found there to be no reduction in breast cancer mortality from self-exams. So BSEs are only one small part of prevention. They can not and should not be used as the only means of detecting problems. Mammograms and clinical exams are more effective.
  • They’re a great way to get to know your body! You’re better able to catch any changes, which you can then discuss with your doctor. Also, they can be positive for your love play! Partner(s) can also be involved in exams, which can help keep them from getting boring.
  • They can lead to false positives (thinking that there’s something seriously wrong when there isn’t), which can be stressful and costly, and false negatives (thinking there’s nothing wrong when there is), which can be fatal.

Who can do them? Almost anyone! The American Cancer Society says that women over the age of 20 should consider doing BSEs. Men can also do BSEs (I would assume with the same age caveat), as can transwomen and transmen. Personally, I think it’s an especially good idea to self-examine (even casually) if you’re doing any kind of sex that’s rough on the breast or nipple….not to detect cancer (trauma to the breast does not cause cancer – Source) but to be better able to detect injury.

When should you self-examine?

  • Menstruating people (that’s most genetic women of childbearing age, folks!) should self-exam right after a period finishes. Breast tissue changes with hormone fluctuations, and right after a period is the best time to detect lumps. Those with very irregular periods should ask their doctor about timing.
  • Men and anyone else who does not menstruate can self-exam at any time during the month. Pick a day!
  • Transwomen and transmen should consult their doctor. There are no studies yet on the incidence of breast cancer for trans folks.

How do you do a BSE? The full instructions can be found at and webMD. Here’s the CliffsNotes version:

  • Look at the breast! Check especially for odd dimples or wrinkles in the skin. Move the breast around – both with your hands and by moving your arms and flexing your chest muscles.
  • Pull on the nipple (gently) – does it produce odd discharge? Bloody or clear discharge can be a warning sign.
  • Now comes the fun part! Ideally using your 2nd, 3rd and 4th fingers, feel for changes in the breast tissue. This should be done with dime-sized circular motions, in a vertical pattern (check the ACS website for diagrams). Do this both standing and lying down, and with light, medium and heavy pressure. Here, you’re looking for unusual lumps and/or texture changes.
  • Your physician can confirm your technique. Please consult him or her if you feel any changes (especially new lumps!) from last month’s exam.

What are you feeling?

  • These diagrams may help: Wikimedia, Mount Nittany, Beth Israel Medical Center, and Vulva University (note: these are female breasts. Male breasts are different).
  • At birth and during childhood, male and female breasts are the same. Female breasts change at puberty in response to changing hormones.  These changes can be induced later in life with hormones, as many transwomen already know.
  • Random fact of the day: The glands that produce milk are actually modified sweat glands – so milk is modified sweat!
  • The apparent visible anatomy is the nipple and the areola (the colored area around the nipple). The nipple is where milk flows (through “lactiferous tubules”), and it’s also got a lot of nerve endings. It can become erect with stimulation, sexual excitement, or cold. Both the nipple and the areola differ in size, shape and color depending on the person, stage of life, and reproductive history.
  • Breasts are mostly fat and connective tissue. In women, the connective tissue includes Cooper’s suspensory ligaments of the breast (named after Sir Astley Cooper, who first identified them). They’re not true ligaments – true ligaments connect bone to bone – but they do help support the breast. They sit right underneath the skin, and they may contract around tumors, potentially producing a wrinkled appearance in the skin. Men generally do not possess these ligaments.
  • Female breasts contain glands (glandular lobules) which drain into ducts, which connect to tubules at the base of the nipple. Men generally lack the glands, but still have the ducts and tubules – which is part of the reason they can also get breast cancer. In fact, while men are less likely to get breast cancer, they’re also much more likely to die from it because it’s detected later in men than in women (Source).
  • I’ve had a really difficult time figuring out what changes in the breast when a transwoman starts hormones (e.g., does she develop Cooper’s ligaments?). If anyone knows these little anatomical details, please let me know!

So, in summary: First, talk to your doctor about doing BSEs. She or he can advise you on whether or not it’s right for you to do BSEs, based on your health and family history. Second, get to know your body! BSEs are one way of doing that.

Finally, try out these videos:

How to perform a breast self exam Contains female nudity. The best instructional video I’ve seen so far.

Partner breast exam Funny! Heterosexual-oriented

  3 Responses to “Prevention: Breast self-exams”

  1. With regards to trans women and when to self-examine: I’m going to go out on a limb here and guess that the hormone which the breasts are most reacting to is the spike of progesterone entering the luteal phase? In that case it would make most sense for trans women to test a day or two after taking their projesterone, if any, or right before a hormone injection (estrogen is an anti-androgen and progesterone is an androgen, as is testosterone).

    PS: I can’t get the accessible captcha to work right, it just gives me another picture. Fix please?

    • I’ll work on the captcha – we’ll talk more about that via e-mail.

      Re: hormones. The recommendation is for menstruating women to perform the exam after the end of their menstrual phase. This would place them at the beginning of the follicular phase, where all the hormone levels are lowest. This is for multiple reasons: a) it’s the most easily remembered and solid time, given that menstrual phase length can vary, b) to avoid having an exam when breasts are tender or swollen because of PMS, and c) the breast tissue should be at its least swollen at this time, making lumps easier to feel.

      I’m not certain the cycle would apply to transwomen unless she’s also hormonally cycling with breast tenderness and the like. In which case…it might be worth doing self-exams over a cycle and see how they change anyway. But I would guess that when the hormones are the lowest is the best time. And if her hormones are steady: just pick a date and stick to it. 🙂

      As always, though, ask a physician to be sure. 🙂

      • Ah, and here I was thinking there was something magical about having plumper breasts. As for trans women’s cycles: yes, my breasts change in consistency depending on how long it has been since I’ve had a shot and I *know* that, for those who cycle progesterone, it has a predictable effect on breasts with the breasts becoming fullest shortly after progesterone spikes.

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