GIRLS Breast Cancer Screening Method
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GLANCE in the mirror with both arms up. Look at the bottom of both breast's and nipples for puckering/lifting or odd bulging. You are looking for a change to one of your breasts, something that wasn't there before.
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INSPECT the skin. Look for patches of dry skin, red areas or new skin changes. Next time you're in the grocery store look closely at an orange; this dimpled/cracked appearance on your breast can be a type of cancer
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ROUND circles feeling for new growths. You will always find a mass, this is normal. Start at your breastbone and slowly circle inward. Push deep into the chest. Use a couple fingertips on both hands and when you find a mass it should easily slide back and forth under your fingers. You will feel a lot of masses; the goal is everything you feel slides back and forth freely under your fingers. Normal breast masses feels like a quarter sized area, this is normal milk producing tissue. Cancer is like a rock and fixed to the chest. It cannot move easily because it produces roots that drive into the surrounding tissue. Circles get smaller every lap. After a few laps you will finish at your nipple.
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LYMPH NODES. With your arm down by your side use the other hand to reach up into your armpit and push inward towards the ribs. Don't lift your arm up because you cannot feel deeply into your armpit. You are feeling for new growths/rocks in your armpit. Lymph node enlargement can be the first sign of breast cancer. This is called a "Sentinel" node.
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SQUEEZE the nipple and look for a discharge. This is the number one breast cancer currently. Brown or red/bloody discharge can be a sign of cancer in the milk ducts of your breast. You may also see this discharge in your bra.
- Examine monthly
- 2 weeks after your cycle
- Lay flat on the bed to "pancake" out your breast
- Mark off your monthly GIRLS exam card
If you have ANY QUESTIONS call your Physician. The majority of my patients who come in with questions turn out to be nothing more than normal breast tissue. This is a perfect scenario ; you want to be vigilant and make sure any changes are not cancer.
Here is a video of the exam I teach patients every year for home breast cancer screening
(Dont worry, its G rated!)
What is the evidence?
Some cancer groups say do your exams, other say "No"
The GIRLS method offers life saving home breast cancer screening that is better than a mammogram at finding aggressive tumors.. For nearly a quarter century I have been practicing evidence based medicine. This means I try to convey information that has reproducible solid evidence backing it. This is not snake oil sales like your reading with "toxin purifying" pills or "stem cells" fix all. This is a solid, medically based proven method for early breast cancer detection.
Research in medicine can be filled with contradictory statements, Home Breast Exam (HBE) is definitely one of these areas. Multiple cancer societies in the US do not recommend performing HBE. The basic reasoning behind this is the death rate appears unchanged comparing women who perform or do not perform monthly HBE. The majority of these groups do recommend annual Clinical Breast Exams (CBE) performed by the physician at your yearly appointment. The reasoning for this recommendation is that CBE is as good as mammography at detecting early breast cancer and early detection saves lives. Hmm, if a better exam detects more cancer then why don't we... TEACH A BETTER EXAM!
As physicians we learn the breast exam in medical school. The CBE has 5 points, we teach it yearly to our patients. Problem is that even with educating our patients only about 5% of women perform a complete exam every month. The GIRLS method helps you remember the 5 points and has a monthly reminder card. I have been using this in my clinical practice and my patients performing a full 5 point HBE has skyrocketed.
Complete breast cancer screening has 3 components; HBE, CBE and annual mammography. I start screening my patients with mammogram at 40 and teach the GIRLS method at 30, talk to your Doctor about your timeline for starting breast cancer screening. This exam is not intended to replace your yearly exam or the mammogram process. My goal is improving early detection through training patients with the same quality of exam at home that is performed in their doctors office.
About Us
Eric Holtrop, MD
Eric Holtrop, MD
Eric Holtrop, MD
CEO and Founder. Board certified in Internal Medicine and Hospital Medicine (ABIM, American Board of Internal Medicine). Over 20 years clinical experience. Passionate about enjoying time with my family, anything on 2 wheels, windsurfing and flying. "You can't stop the waves but you can learn how to surf."
Helen Zurek
Eric Holtrop, MD
Eric Holtrop, MD
CFO and Co-Founder. 30 years experience directing hospital based medical record departments. 4 time national triathlon champion and multiple years Team USA .
Our Company
Eric Holtrop, MD
Our Company
We are a breast cancer detection company with a passion for athletics. We encourage all athletic endevours. Triathlon, cycling, motocross, windsurfing; if your hitting it hard we are behind you! We work with healthcare companies and industry to promote early detection at home, in the clinic or at the job site.
Selected Research Publications
CBE = Clinical Breast Exam; your Dr's exam in the office HBE = your Home Breast Exam
1. CMAJ June 26, 2001; 164(13) Harvard evaluation. Discuss why some recommendations of not performing HBE may be shortsighted. 2400 women studied, 10 years.
2. J Gen Intern Med 28(5):719–22 Breast cancer discovered by CBE is more aggressive. Younger women get more benefit from CBE than mammogram because of dense breast's. 13% of mammogram missed breast cancer found with exam. CBE about the same as mammogram at finding cancer.
3. Curr Oncol. 2016 Aug;23(4):e332-e339 A significant number of cancers would have been missed if CBE had not been performed. 9% of breast cancer caught by CBE alone. Breast cancer is the most common type of cancer in women, about 12% of all women.
4. Cochrane Database of Systematic Reviews 2017, Issue 1. 1.7 million cases worldwide of breast cancer. Rates are lower in low income countries, but death rate is higher. Improving CBE quality results in less stage 4 diagnosis.
5. Am Health Drug Benefits.2016;9(1):23-32 Cost to treat stage 1 breast cancer is $72,000, stage 4 ia $183,000. It killed over 40,000 women in 2015, lung cancer is still the leading cause of cancer death. Survival is improving in the USA.
6. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 81, NO. 7 Racial differences in HBE screening. Less black women are performing HBE
7. UpToDate; Screening for breast cancer: Evidence for effectiveness and harms, 2020. 27 less deaths per 10,000 screened in Norway using CBE. Technique is very important for detecting early breast cancer (the reason I came up with a reproducible breast exam method.) There is increased risk for death or metastatic disease (OR 2.20, 95% CI 1.30-3.71) in women who did not perform technically correct breast self-examination . A 35 percent decrease in advanced-stage breast cancer compared with women not performing breast self-examination.
8. BMC public health 2007, 7:57 Black women have higher death rates than white for breast cancer, how to overcome fears of HBE/CBE
9. Infectious Agents and Cancer 2009, 4(Suppl 1):S14 Caribbean women screen with HBE/CBE at low rates due to cultural fears. (Near to my heart since I trained for years in the Caribbean)
10. World J Clin Oncol 2019 February 24; 10(2): 98-109 Breast cancer is the most common cancer in women worldwide. Obesity and excessive alcohol are large risk factors in developing breast cancer.
11. OSHPD, 2018, Cancer Surgeries (Volume) 29,000 breast cancer surgeries in California per year, the #1 cancer surgery. 4 times higher than second place colon cancer (7,600 cases)
12. UpToDate; Screening for breast cancer: Evidence for effectiveness and harms
Thermograms; Approved by the FDA because they are safe but NOT effective at screening for cancer. Seems like a reasonable alternative to mammography, reality is that it doesn't find cancer
Take home messages
- More screening is a good thing, cancer is rising
- Quality CBE will find about 10% more cancers than mammogram alone
- Quality CBE leads to finding at an earlier cancer stage = improved survival
- Obesity drives cancer; go to Weight Watchers
- Alcoholism is lethal, limit alcohol to one drink per day
Learn More
Medical research is hard enough when you have an MD and 12 years of college, its impossible for the average patient. The majority of physicians in the United States look for current evidence based data on a site developed by Harvard University. They offer a free site for patients and it is the best place to start for any medical questions. Click this link and search for any medical issue.