“I found a lump.”

It’s the unsettling phrase providers sometimes hear from women when they are performing their monthly breast self-check for cancer signs.

But lumps are not the only thing to watch for, says Heather Chambers, an OSF HealthCare breast health navigator who is herself a breast cancer survivor.

Signs to know

Each month, keep these in mind.

• Lumps, the most talked about sign.

“A lot of women, especially younger women, have very dense breasts. Sometimes it feels like a bag of rice with little bumps. That’s just the tissue,” Chambers says. “When you feel a hard nodule, fixed in place or sometimes mobile, you definitely want to get that reviewed.”

• Skin changes. This could be an orange peel skin appearance, flaky skin, irritation or a new dimple.
  
• Unexpected release of fluid or blood from the nipple. For example, if you are not breastfeeding, a nipple discharge would be unexpected.
  
• Unexpected inversion of a nipple.
  
• One breast larger than the other, or generally, any unexpected change to breast size.
  
• Any new pain in breast area.
  
• Tenderness, swelling, pain or lumps under your armpit. This is one some women may overlook since it doesn’t deal with the breasts.

“Your lymphatic system drains to armpits,” Chambers explains. “So, if there’s anything going on in the breast, it’s going to show up in your armpit eventually.”

When and how

Chambers recommends women pick a date each month for a self-check and stick with it. The first of each month, for example. This way, you can put it on your calendar, and it’s easy to remember. And, she says the feel of your breasts will change as days go by. But, choosing the same time each month gives you a baseline feel and helps avoid false positives. Chambers also advises making your chosen date a week after your menstrual cycle ends.

Chambers says many women find it convenient to examine themselves in the shower. Regardless of where, she says a good technique is to move your fingertips in a circle from the outside to the center of the breast, pressing down and feeling for abnormalities. Then, do the same under each armpit. And also, glance in the mirror for a good look at visual signs, such as one breast larger than the other.

Some women have a trusted adult, like a spouse, also feel their breast for a second opinion. Others may take photos during their self-check to show their provider. Both ideas are acceptable, Chambers says.

“When you go to the doctor, they can look at the picture. If the abnormality has changed or gone back to normal, then we know it’s nothing to really worry about. But if the issue has increased in size or looks worse, it’s something to be concerned about,” she says.

What happens next

If you find something concerning in a self-check, call your primary care provider or OB/GYN right away and explain what you found. Chambers says the provider will likely order a diagnostic mammogram, an outpatient procedure at a doctor’s office. The radiologist should read the results on the spot. If a closer look is needed, you may undergo an ultrasound, another way to image the breast, or a biopsy, which takes a tissue sample for testing.

It's important not to panic, Chambers stresses. If you have severe pain or an abscess, you should go to the emergency department. But for abnormal findings on a self-check, that’s not necessary.

“If you go to the emergency department with a lump, they’re going to send you home, and you’re going to have to go through the process of calling your provider.

“Breast cancer is not going to change that drastically in three to four weeks,” Chambers adds. “It’s not going to make that big of a difference. However, you want to get yourself scheduled and be proactive. Don’t say ‘Oh let me watch it for a few months and see if it changes.’”

But do keep track of any changes between when you make the appointment and appointment day.

Why it’s important

Chambers says a monthly self-check goes hand-in-hand with regularly scheduled mammograms as the most important ways to prevent breast cancer. You should talk to your primary care provider or OB/GYN about what mammogram schedule is right for you.

“Typically, we do a mammogram every year to get the breast image,” Chambers says. “But during the year, things can develop that you don’t notice. Some things can develop very quickly.

“By doing a monthly exam, you learn your body. You know how it feels,” she adds. “Each month you may say ‘Well I didn’t remember that there last month.’ So you can address it right away.”

Early detection is key for a better outcome. Conversely, unchecked breast cancer is a major killer in the United States. The American Cancer Society estimates about 43,700 women will lose their life to the disease in 2023.

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