How breast size dissatisfaction affects breast self-examination

Breast cancer is the most common cancer diagnosed in the United Kingdom. In 2015, 45,764 cases of breast cancer in women were registered in England, accounting for nearly 1 in 3 new female cancer cases. Women with breast cancer in the United Kingdom also have poorer survival rates than women in other parts of Europe. One reason for this is that British women tend to be diagnosed at more advanced stages of disease, which reduces survival rates.

Regular attendance at mammography screenings is an effective way of detecting breast cancer early. In England, women between the ages of 50 and 70 are invited for breast screening every three years as part of the NHS Breast Screening Programme. Screening is intended to detect breast cancer at an early stage, when there is a better chance of successful treatment. However, most breast cancers are detected by women through breast self-examination, which involves regular palpation of the breasts.

However, done on its own and without proper training, breast self-examination may not provide any clear benefit for early breast cancer detection. In the UK, healthcare policy no longer advocates regular breast self-examination and instead promotes “breast awareness”, which involves familiarity with one’s breasts and the way the breasts change throughout one’s life. It involves women gaining an awareness of how their breasts look and feel normally, as well as developing the confidence to notice any change (e.g., changes in size, swelling, pain, lumps or thickening) that might help detect breast cancer early.

A woman’s body image – or their subjective perceptions of their bodies – may be an important factor that affects breast awareness. This is because breast self-examination requires physical examination of, and attentiveness to, one’s own body. But the few studies that have examined this possibility have been inconclusive, with some studies finding that negative body image is associated with lower frequency of breast self-examination and others finding no association. These mixed findings may be due to the fact that studies have focused on women’s dissatisfaction with their overall bodies, rather than breast dissatisfaction specifically.

A colleague and I wanted to know whether breast size dissatisfaction affects breast self-examination. To do this, we asked an online sample of 384 British women to complete measures of breast size dissatisfaction and more general body dissatisfaction. We also asked how frequently they engaged in breast self-examination, how confident they felt about detecting a change in their breasts, and how quickly they would see their doctor if they did detect a change.

In our study, published in the journal Body Image, we found that a majority of our participants were dissatisfied with their breast size, with 31% wanting smaller breasts than they currently had and 44% wanting larger breasts than they currently had. In terms of breast self-examination, a third never examined their breasts, about a fifth self-examined once every six months, about a quarter once a month, and about a fifth at least once a week. More than a half of participants were not at all or only slightly confident of detecting a breast change, though just over a half said they would visit their doctor as soon as possible if they did detect a change.

Importantly, our findings showed that women who experienced greater breast size dissatisfaction, but not body dissatisfaction more generally, were less likely to engage in frequent breast self-examination. Our results also showed that both women who desired larger and smaller breasts than they currently had were less likely to engage in regular breast self-examination. Women with greater breast size dissatisfaction were also less confident about detecting a change in their breasts and were more likely to delay seeing their doctor if they did detect a change. In short, it seems to be dissatisfaction with one’s breasts specifically, rather than one’s body as a whole, that has an influence on breast self-examination frequency and related behaviours.

The most likely explanation for our findings is that, for women who experience breast size dissatisfaction, breast self-examination acts as a threat to body image. Breast self-examination involves visually inspecting each breast and feeling each breast to detect changes. For women who are dissatisfied with their breasts, having to visually and manually inspect their breasts may trigger negative body-related thoughts. To avoid such negative thoughts, women with breast size dissatisfaction may avoid performing self-examination. In other words, women who experience breast size dissatisfaction may avoid performing breast self-examination because it draws attention to the site of their dissatisfaction.

Breast size dissatisfaction may also trigger negative self-conscious emotions, such as shame and embarrassment, that result in lower breast awareness. As Cornelia Baines once put it, breast self-examination “neither makes one feel better for having done it nor makes one more attractive”. Instead, breast self-examination – which asks women to ritually investigate whether they have been “betrayed” by their breasts – may trigger negative feelings about the body because it forces women to treat their bodies as objects.

Our data were cross-sectional, so causal inferences should be drawn with caution, and we only focused on a single aspect of breast dissatisfaction. Even so, our findings suggest that promoting breast size satisfaction may be one way of increasing breast self-examination frequency and more positive behaviours in response to detecting breast change. For example, there is some evidence that promoting breast awareness helps women to view their breasts in more functional, rather than purely aesthetic terms, which in turn may empower them to take a more active role in breast self-examination. Until such interventions become available, healthcare professionals should be mindful of the impact that dissatisfaction with one’s breasts may have on self-examination behaviours. 

Viren Swami  is Professor of Social Psychology at Anglia Ruskin University. His research on human appearance and body image is focused on the influence of culture on beauty ideals an practices, as well as the socio-political underpinnings of corporeal experiences. He is the author of The Missing Arms of Venus de Milo, The Psychology of Physical Attraction, and Attraction Explained: The Science of How We Form Relationships.