Whole Health: Breast Exams
Last month I saw Genevieve, a 47-year-old patient, for her annual physical. When I asked whether she'd been doing breast self-exams, she hesitated and smiled sheepishly. We'd been having a frank conversation about her health and her life. "Well, honestly, I never feel comfortable doing them," she said. "I know I should, but I don't ever think I'm doing them right."
Genevieve's response is very common.The majority of my patients, educated and health-conscious women, confess that, despite reminders from their physicians and the media, they don't do self-exams regularly. When I ask why, they explain that they don't feel qualified. Most don't know what they should be feeling for, other than "something bad," and they're afraid they'll miss something important -- or find something scary. The small percentage of my patients who perform self-exams tell me that they do so with worry, even fear.
These are completely understandable feelings, and, in fact, in recent years the medical community has been turning away from self-exams. In 2001, the Canadian Task Force on Preventive Health Care reviewed studies and found no evidence that women who performed breast self-exams live longer. They also found that women who did self-exams saw their doctors more often to report suspicious findings and consequently had much higher rates of benign biopsies (and associated scarring, pain, and worry). Given these results, the task force recommended that women ages 40 to 69 not be routinely taught to do breast self-exams, and added that self-exams may be particularly misleading for women under 40.(The glands of young women's breasts are especially active, leading to changes in breast tissue that can be mistaken for lumps.) The U.S. Preventive Services Task Force made similar recommendations in 2002.
On the face of it, these recommendations are logical, but in my view telling women to ignore their breasts is missing the point entirely. I believe that self-exams are a good idea, just not in the way they've been framed by the medical establishment -- and then internalized by women. The prevailing attitude is that self-exams should be done like clockwork once a month to "look for cancer," and women feel largely responsible for this themselves, almost as if they are their own doctor. No wonder my patients are intimidated and frightened.
You should not, of course, be expected to act as your own physician, and breast self-exams should not be some dreadful, anxiety-ridden duty. What self-exams should be -- and can be -- is a regular opportunity to be in touch with your body (literally and figuratively) so that you know what is normal for you. I laugh with my colleagues and patients about starting a national Love Your Breasts campaign -- but I'm half serious. We're paralyzed with fear, and we need a 180-degree shift in attitude.
The first step, as I tell my patients, is to stop thinking in terms of self-exams (a loaded term if there ever was one) and start getting to know your breasts, regularly. At least once a month, check in with them. Suspend any judgments you might have about their size or shape, as well as any thoughts of "finding" something, and simply pay attention. Take time to touch and feel your breasts, to look at them, and by all means to love them.
It's a shift in mind-set more than in technique; you can still use the self-exam instructions your doctor has shared with you. I often recommend starting in the shower, when your skin is wet and you're already in touch with your body. Rather than just going through the motions, take the time to thoroughly explore your breasts. What do they feel like? And don't just feel your breasts -- appreciate them. After drying off, lie down and apply lotion to your skin, noticing each area of your body but paying particular attention to your breasts. How do they feel when you are lying down? What do you notice?
I've found that women who use this approach, far from avoiding or "forgetting," look forward to these breast check-ins. If you do them regularly, at least monthly, and years from now something changes, you will know it. And beyond this, you will start establishing an intimate, conscious relationship with your body, one that will not only enhance your health but also allow you to reconnect with the joy of living in your female body.
Dr. Tracy Gaudet; illustration by Sandra Dionisi