Monthly Breast Self-Examination Instructions
The American Cancer Society no longer recommends routine monthly breast self-examination (BSE) as a screening method, as research has shown it does not reduce breast cancer mortality and leads to increased unnecessary biopsies. 1, 2
Current Evidence-Based Recommendations
What Women Should Know About BSE
Women should be informed about both the potential benefits and limitations of BSE, including the risk of false-positive results that may lead to unnecessary biopsies. 1
Women may choose to perform BSE regularly, occasionally, or not at all after being educated about the evidence. 1
The most important message is breast awareness: women should know how their breasts normally look and feel and promptly report any changes to their healthcare provider, whether discovered during formal BSE or noticed incidentally. 1
If a Woman Chooses to Perform BSE
Women who opt to perform periodic BSE should receive proper instruction in the technique and have their technique reviewed periodically by a healthcare provider. 1
BSE Technique Components
When performing BSE, the examination should include: 3
- Visual inspection with the patient sitting, hands on hips, assessing for symmetry and skin changes
- Systematic palpation of all breast tissue and nearby lymph nodes
- Both inspection and palpation methods to detect any changes in the breast 4
Timing for BSE
Women with regular menstruation should perform BSE monthly, preferably on the fifth or seventh day after menstruation when breast tissue is least tender and swollen. 4
BSE can begin in a woman's 20s if she chooses to perform it. 1
Why the Recommendation Changed
Evidence Against Routine BSE
Two large randomized trials involving 388,535 women showed no reduction in breast cancer mortality from regular BSE (relative risk 1.05,95% CI 0.90-1.24). 2
BSE led to nearly twice as many benign biopsies compared to no BSE (3,406 vs 1,856 biopsies, relative risk 1.89). 2
Research demonstrated that BSE plays a small role in finding breast cancer compared with incidental discovery of lumps during normal daily activities. 1
What Should Replace BSE
Recommended Screening Approach
Women ages 20-39 should have a clinical breast examination (CBE) by a healthcare provider at least every 3 years as part of a periodic health examination. 3
Women ages 40 and older should have annual CBE and annual mammography, with the CBE ideally performed shortly before the mammogram. 3, 5
Breast Awareness Education
Healthcare providers should use the CBE visit to educate women about breast awareness, emphasizing the importance of promptly reporting any new breast symptoms. 1, 3
Women should be counseled to report any unexpected changes including lumps, skin changes, nipple discharge, or other abnormalities. 3, 5
Common Pitfalls to Avoid
Do not promote BSE as equivalent to mammography or CBE for breast cancer detection—the evidence does not support this. 2
Avoid creating anxiety about perfect BSE technique—heightened breast awareness through any means (formal BSE or casual awareness) is what matters most. 1
Do not dismiss patient concerns about breast changes even if they don't perform regular BSE—most breast cancers are found incidentally. 1