The most recent American Cancer Society guidelines for breast self-exams encourage women to examine their breasts while lying down as well as check for abnormalities while standing in front of a mirror.
The older recommendations suggested women to examine their breasts in the shower for lumps or other changes after their menstrual period. Casey Moffa, an oncologist with the West Penn Allegheny Oncology Network, said doctors figured that women were more likely to do the exam when they were already naked.
The new recommendations are designed to encourage women to be familiar with their breasts so they're more likely to notice changes, Dr. Moffa said.
The guidelines suggest a woman conduct the exam lying down with one arm behind her head. When a woman is lying down, the breast tissue spreads over the chest more evenly, making it easier to feel all of the breast tissue. Dr. Moffa recommended putting a pillow under the shoulders to further flatten the breast tissue.
Use the pads of three middle fingers -- not the tips, Dr. Moffa noted -- to make overlapping dime-sized circular motions in a vertical grid pattern over the whole breast, up to the collarbone, out to the armpit, in to the middle of the chest, then down to the bottom of the rib cage. Use light, medium and firm pressure on each area of the breast to ensure all of the tissue is felt. When pressing firmly, women should be able to feel their rib cage, Dr. Moffa said.
The recommendations also encourage women to stand in front of a mirror with her hands on her hips and look for nipple discharge, redness, scaliness, dimpling and any changes in the shape, size or contour of the breast.
While older guidelines recommended women perform the exam after their monthly period, the new recommendations say "it is acceptable for women to choose not to do breast self-exams or to do [them] occasionally."
Dr. Moffa said it's still best to do it as often as possible and to have a breast exam performed by a physician annually, but the goal is to make sure women are familiar with their breasts so they notice when something changes.
"The patient is always the best judge of something like that," she said.
She noted that breasts feel different throughout the menstrual cycle and when a woman is breastfeeding or pregnant, and women shouldn't avoid doing breast self-exams during those times.
"It's not a time you want to neglect" your breasts, she said of performing breast self-exams while breastfeeding or pregnant.
Dr. Moffa said some women are intimidated or uncomfortable with breast self-exams. If that's the case, she recommends just standing in front of the mirror and lifting each arm to make sure both breasts move the same way.
If a woman does that every day, Dr. Moffa said, she's more likely to notice abnormalities.
"Do whatever you feel you can do because you are the best judge if there's a change," she said. "If you're concerned about something, contact your physician and have it looked into further."
A more detailed explanation of the breast self-exam can be found by going to www.cancer.org and searching for "breast self-exam" and then clicking on "breast awareness and self-exam."
Annie Siebert: firstname.lastname@example.org or 412-263-1613. Twitter: @AnnieSiebert