How faithfully do you do your monthly breast self-exams? If you're like most women, breast examination is a sporadic ritual, if ever done.

Let's face it, palpating and examining the breasts is a cumbersome, time-consuming chore – much like flossing our teeth. While our intentions are honest and good for both these essential rituals, it's just so easy to forget them. Oddly enough, the regular practice of both these chores – er, habits – will yield a lifetime of health and body awareness.

Why do a breast self-exam?
We all know why we should do regular breast self-exams (BSEs): breast cancer is horrific and deadly, and it's not going away. According to the Canadian Cancer Society, an average of 429 Canadian women will be diagnosed with breast cancer every week this year, and every week 102 women will die from it. One in nine women will be diagnosed with breast cancer in her lifetime.

Barb Bryson, communications manager of the Canadian Breast Cancer Foundation, says it's important for healthy women to know what their breasts look like and feel like normally. "The only way you can sense a change is if you know what 'normal' is," she explains. She stresses that any change should be reported immediately to your health care professional.

What should you look for?
It's not just lumps you're watching out for. There are many things that could indicate compromised breast health which must be reported immediately to your health care professional. Here is a complete list of what you need to look for:

1. Lumps
• Constantly present – do not come and go with menstrual cycle.
• May feel like they are attached to the skin.
• May feel hard and different from the rest of the breast tissue.
• May be tender but not necessarily painful (though new or unusual pain should also be reported).
• Lumps in the armpits – breast tissues also extend into the armpits. Lumps in this area may indicate cancer has spread to the lymph nodes.

2. Breast changes
• A change in the outline of the breast.
• A change in the size of the breast.

3. Nipple changes
• A nipple that suddenly becomes inverted, or the direction of your nipple changes in any way.
• Nipple that leak (without squeezing) and the discharge is bloodstained.
• Crusting, eczema-type symptoms or a rash on the nipple may indicate a rare form of breast cancer.

4. Skin changes
• Thickening and dimpling skin, like an orange peel.
• Puckering skin.
• Redness, swelling and/or increased warmth.
• Round, itchy areas.
• Distended veins on the breast in an irregular pattern.

Visit breastselfexam.ca for images of changes to look for.

How to do a proper BSE
We've all seen the doorknob hanger diagrams with squiggly lines fanning a nipple, looking rather methodical and painstaking. These diagrams illustrate a thorough methodology for BSEs and are recommended for optimal examination, but this is not the one and only way to do them. Dr. Verna Mai, director of screening programs for Cancer Care Ontario, says the point of BSEs is to know your breasts.

"There are various BSE techniques and it's not possible to say which method is better," she says. "Basically, do whatever works for you. There are such strong messages in terms of how to do an exam and when, but they just haven't had adequate scientific scrutiny. The technique of a BSE is a process of looking and palpating. That's all."

Breastselfexam.ca, funded by the Canadian Breast Cancer Foundation, is a multimedia website built by the Thunder Bay Breast Health Coalition and gives excellent instructional advice on how to examine your breasts. The following are some of their tips on how to do a BSE.

1. Look
Stand in front of a mirror and observe your breasts:
• while standing
• with your hands on your hips
• turned sideways and leaning over slightly.

2. Feel
• Use soap or lotion to help you explore your breast tissue.
• Use three fingers – index, middle and ring finger – to examine your breasts.
• Apply firm but gentle pressure.
• Compare both breasts evenly – you should feel the same or similar things in both breasts.
• Check the whole breast area – from under your arms up to your collarbone.

3. Examine
Use what feels comfortable and works well for you, either standing up or lying on your back or side.
• Clock pattern
• Circle pattern
• Grid pattern

Click here for an image of these three examining patterns.

4. Record
Record the date and any changes in a journal, a calendar or anything that works for you.

Part of overall breast health care
Barb Bryson says BSEs are part of a "triad approach" to maintaining healthy breasts. The Canadian Breast Cancer Foundation recommends three steps towards breast health:

Step 1: Monthly breast self-examination beginning at age 20

Step 2: Clinical breast exam performed annually by a qualified health-care professional

Step 3: Mammography every two years from ages 50 to 69 (or according to your provincial/territorial health plan)

She cautions that no single detection method is foolproof, but that early cancer detection offers the best chances for a healthy outcome. Performing BSEs and knowing your breasts are the first steps toward a lifetime of healthy breasts.

More useful websites:

www.cbcn.ca
The Canadian Breast Cancer Network. A bilingual site including resources and news on breast cancer.

www.007b.com
An extremely useful "breast" website, including breast photo galleries of all sizes, nipple shapes and ages.