Breast Self-Examination
Regular breast self-examination (BSE) helps people become familiar with the normal appearance and feel of their breast tissue, making it easier to notice changes. The recommended approach is monthly, typically a week after the start of the menstrual period when hormonal tenderness is lowest. The examination involves both visual inspection (looking for shape changes, skin changes, nipple changes) and manual palpation (feeling systematically for lumps, thickening, or asymmetry). Both lying down and standing positions are recommended.
What to Look For
Changes that warrant prompt medical evaluation include: a new lump or thickening, changes in breast shape or size, skin dimpling or puckering, nipple inversion (if new), nipple discharge (particularly bloody or from one duct), skin changes resembling orange peel texture, or any area that feels distinctly different from surrounding tissue. Most breast changes are benign, but changes should always be investigated promptly.
Mammography
Mammography is X-ray imaging of the breast and remains the primary screening tool for breast cancer. Standard mammography uses two views per breast (mediolateral oblique and craniocaudal). Digital mammography has largely replaced film-screen in most countries. 3D mammography (digital breast tomosynthesis) improves detection rates, particularly in dense breast tissue, and reduces recall rates.
Breast Density
Breast density refers to the proportion of glandular and fibrous tissue relative to fat on mammography. Higher density makes screening harder (dense tissue and tumours both appear white) and is itself an independent risk factor. The FDA now requires radiologists to report breast density to patients in the US. Supplemental screening with ultrasound or MRI is recommended for women with very dense breasts.
Breast Health With Implants
Implants can obscure breast tissue on standard mammography views. Implant-displaced (ID) views are used alongside standard views to image as much tissue as possible. Ultrasound and MRI are frequently used as supplemental tools in augmented patients. Implant-based screening does not reduce the importance or frequency of breast examinations.
