For many years, decades even, medical organizations and doctors preached the importance of breast self-exams (BSE) in the fight against breast cancer. And with good reason: Breast cancer is the most common cancer diagnosed in American women, with a 1 in 8 lifetime risk of developing it. 

And early detection—along with improved treatments—has been credited as a key factor for helping reduce mortality rates from the disease, according to the American College of Obstetricians and Gynecologists (ACOG). The five-year survival rate is now 90%, vs 75% in 1975.

You may have read recently about newer guidelines about the benefits of self breast exams. It is really just an update on the concept. Today, these many health organizations advocate for what’s called breast self-awareness (BSA). Which essentially means being aware of the normal look and feel of your breasts so you can quickly ID anything out of the ordinary. 

 The goal of BSA is to have an understanding of your breasts in a healthy state, so that you’ll be able to recognize any changes. This is still extremely crucial, as about 50% of breast cancer cases in women 50 and older, and 71% of cases in those younger than 50, are found by women themselves.

It’s important to note that a change in look or feel doesn’t necessarily mean you have breast cancer. But it could be a risk factor or sign. It’s always better to err on the cautious side, so alert your doctor right away if you notice anything different. With breast self-awareness, here are five key things to pay attention to.

1. Lumps or Masses

Any bump can seem scary, but many of them are normal. Lauren Beasley, M.D., an obstetrician-gynecologist, advises her patients to think of their breasts like a constellation in the sky. “You may have a little cluster of firmness in one place that's always been there and perhaps in another as well. There will usually be a bit of density in the breast,” says Dr. Beasley, who practices with Centre Obstetrics and Gynecology in Raleigh, NC. 

“But if you notice any change in that constellation, or a new cluster or mass forms, we want to see you right away for examination and testing,” she stresses. This includes any lumps that might appear in the underarm. Often, benign, or non cancerous cysts can resolve on their own, however imaging and biopsy is the only way to know for sure.  It is just not worth the risk to wait and see.

2. Nipple Discharge and Changes

Squeeze your breast and see if any fluid comes out. Any breast discharge, unless you are pregnant or breastfeeding warrants a visit to your doctor. If it’s milky white or greenish, it’s less likely to be breast cancer. Bloody or clear discharge is more concerning—you may have a papilloma, or cyst, in the duct. Again, any nipple discharge other than breast milk warrants a doctor visit. 

There are other nipple changes to watch for, as well. Things like crusting or scaling, or a nipple that has changed shape, need to be examined. So does pain in the nipple area, or pulling in of the nipple. 

3. Skin Changes

If your breasts are dry, it could be a skin issue such as eczema, psoriasis, or an allergic reaction. Or you may have a yeast infection under your breasts, a common condition especially if you have larger breasts. 

Other skin changes may be more problematic. If your breasts are warm or red, or there’s dimpling of the skin, report to your doctor. Ditto if there are ulcers, which are small, red blisters that hurt. 

4. Size and Shape

Unless you’re very young and still growing—or your breasts have started to naturally droop with age (perimenopausal women will commonly see changes due to hormonal fluctuations)—any change in the size or shape of your breasts is a signal to see your ob/gyn. This includes thickening or swelling of any part of the breast.

5. Pain

Pain can occur in any area of the breast and, and is rarely a sign of breast cancer. Pain in breasts is generally a result of normal healthy hormonal changes. There are two overarching pain categories here: cyclical, and noncyclic. 

• Cyclical pain: This is typically the result of hormonal changes and menstruation. It usually occurs right before you start your period, and lessens afterwards. The pain can be mild or intense.
• Noncyclic pain: This often strikes in one breast and one spot. It can be caused by injury, medications, large breast size, or infection. It’s pretty uncommon and rarely associated with breast cancer. 

We’ve said it once (or, erm, four or five times already?), and we’ll say it again: Go to the doctor if you notice any change in your breast. If it turns out to be benign or no big deal, great! It’s better to get things checked out. Practicing breast self-awareness can help you recognize what’s normal for you and help keep you healthy.