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As important as requesting regular mammograms for the early detection of breast cancer, is getting periodic breast exams by a doctor or nurse. You may find it convenient to schedule this exam during your routine physical. If a breast exam is not part of your regular checkup, you should ask to have it done. The examiner will look at your breasts while you are sitting and while you are lying down. You may be asked to raise your arms over your head or let them hang by your sides, or to press your hands against your hips. The examiner checks each breast carefully for changes in the skin, such as dimpling, scaling, or puckering, or any discharge from the nipples, or any difference in appearance, either size or shape. The next step is palpation: Using the pads of the fingers to feel for lumps, the examiner will systematically inspect the entire breast, the underarm, and even the collarbone area, first on one side, then on the other.
A lump is generally the size of a pea before a skilled examiner can detect it. Lumps that are soft, round, smooth, and movable tend not to be cancerous. An irregular, hard lump that feels firmly anchored within the breast tissue is more likely to be a cancer. However, these are general guidelines, not hard and fast rules.
A breast exam by a doctor or nurse can find some cancers missed by mammography, even very small ones. In addition to the skill and carefulness of the examiner, the success of a breast exam can be influenced by your monthly cycle, by the size of your breast, as well as by the size and location of the lump itself. Lumps are harder to find in a large breast.