Breast Cancer Awareness: Self-Exams, Mammograms and Knowing Your Body

October is Breast Cancer Awareness Month. In Episode 03 of Double Dose with the Coopers, Dr. William Cooper and Dr. Ozita Cooper (“Dr. Z”) welcome Dr. Anita Johnson, a surgical oncologist and breast specialist with more than 20 years dedicated to fighting breast cancer. Three doctors, three perspectives.

Part 01 is mostly Dr. Johnson’s own story: how she chose medicine, the mentors who steered her toward breast surgery, and what it took to train as a woman in surgery. Part 02 is the practical half: self-exams, mammograms, what happens after an abnormal result, and how treatment has changed. This guide focuses on Part 02 and the two clips Dr. Cooper posted in October, with what national organizations recommend.

Watch Part 02 and the October clips

1. Self-exams and knowing your body

“As breast surgeons, we still recommend self-breast exams,” Dr. Johnson said. Some medical societies have downplayed them, she noted, but she sees women every day who found a suspicious lump in their breast before imaging did.

Her advice is to start after age 21. If you still have periods, time the exam to your cycle. After menopause, pick one day each month, such as the date of your birthday, and keep it consistent.

She was also clear that a self-exam is not a replacement for screening. Women should still get their screening mammograms.

The common ground: know what is normal for you, have any change checked, and keep up with screening mammograms as recommended.

Changes to get checked

The American Cancer Society lists these signs:

• A new lump or mass, the most common symptom
• Swelling of all or part of a breast, even without a lump
• Skin dimpling, sometimes looking like an orange peel
• A nipple turning inward
• Red, dry, flaking or thickened nipple or breast skin
• Nipple discharge other than breast milk
• Swollen lymph nodes under the arm or near the collarbone

Dr. Johnson added that a lump that stays the same size instead of coming and going needs to be checked, and that women 40 and older should act on a lump quickly. Most lumps are not cancer, but every new one deserves an answer.

2. Mammograms: when to start and how often

Dr. Johnson said screening mammograms, including 3D mammograms, are still the way to find the earliest breast cancers. Not every cancer starts as a lump. Tiny calcium deposits called calcifications can be an early sign, and in most cases they show up only on a mammogram. An ultrasound alone cannot pick up calcifications, she said, although it helps for women with dense breasts.

For most women at average risk, she recommends starting at 40 and going every year, while noting there is some data for every other year after a certain age. She said women can keep screening as long as their life expectancy is more than 10 years.

Ask your doctor which schedule fits your own risk.

3. Dense breasts and newer imaging

Your mammogram report grades breast density from A to D, Dr. Johnson explained, and dense tissue can make cancer harder to see. For women in the denser C and D groups, she said, a breast MRI may be an option, and some centers now offer contrast-enhanced mammography, which uses an IV dye to help see through dense tissue.

She also said artificial intelligence already helps read mammograms at many centers, and that it should assist doctors, not replace them.

4. Called back, or found a lump? What happens next

Dr. Z spoke from experience. She once felt a lump and also had an abnormal mammogram, and she described freezing with fear when the radiologist showed her the area of concern. She had a biopsy with local numbing, and it was not cancer. For her, the mammogram was more intimidating than the biopsy.

Dr. Johnson said callbacks are common. By her estimate, about 1 in 10 women is called back after a screening mammogram for an ultrasound or another type of mammogram, and in most cases it is not cancer.

If a biopsy is needed, most women today get a needle core biopsy: the skin is numbed, a small nick is made, and the needle is guided by ultrasound, or by a mammogram machine for calcifications. Open surgical biopsies are outdated, she said. And when an area does need to come out, many surgeons now find it with a small clip placed inside the breast instead of a wire, which is more precise and can remove less tissue.

5. If it is cancer: how treatment has changed

Dr. Johnson walked through how a treatment plan comes together today:

• Receptors guide the plan. Doctors test the cancer cells for estrogen and progesterone receptors and for HER2. Cancer with none of the three is called triple-negative. For some cancers, especially triple-negative and HER2-positive, chemotherapy, immunotherapy or targeted therapy may come before surgery.
• Not everyone needs chemotherapy. Lab tests on the tumor, such as Oncotype or MammaPrint, help estimate the risk of the cancer coming back. Some women with estrogen- or progesterone-positive cancer may be able to take a pill for 5 to 10 years instead of chemotherapy.
• Many women can keep their breast. A lumpectomy, also called a partial mastectomy, followed by radiation is an option for many women. Surgeons also use oncoplastic and hidden-scar techniques to help the breast look as natural as possible.
• It is the woman’s choice. Dr. Johnson said the decision between lumpectomy and mastectomy is always the patient’s, made with the evidence in front of her. Some women do need a mastectomy, for example when cancer is spread through the breast, and most can have reconstruction the same day.
• Fewer lymph nodes removed. When treatment before surgery works and the targeted lymph nodes come back clear, surgeons can avoid removing all the lymph nodes under the arm. That lowers the risk of lymphedema, a long-term arm swelling.
• Radiation is a local treatment. Chemotherapy and immunotherapy work throughout the body; radiation treats the breast itself. For breast cancer, she said, the most common side effects are tiredness and some darkening of the skin that goes away.
• Emotional support matters. She said conversations about body image should be a standard part of cancer care, but they are not yet available everywhere.

Looking ahead, Dr. Johnson said breast cancer vaccines are being studied in clinical trials, including in women treated for triple-negative breast cancer, and she hopes surgeons will soon use fluorescent imaging to see tumor cells during surgery. Asked what she wants patients to remember about her work, she said she wants to provide them “with hope and the truth.”

6. Why awareness matters for Black women

Dr. Z said one reason she wanted this episode is that more White women are diagnosed with breast cancer, but a greater share of Black women die from it. Dr. Johnson said Black women are sometimes diagnosed later, and some do not trust the health care system, including members of her own family.

Part of her answer is navigation. She praised hospital programs whose nurse navigators, including women of color, help women through every step. The doctors also noted that being underinsured is no longer only about being out of work: many entrepreneurs and gig workers have no health insurance.

If you are facing tests or treatment, ask your hospital whether it has a patient navigator.

7. Lowering your risk

In short videos for Breast Cancer Awareness Month in 2024, Dr. Cooper covered risk factors, steps you can take, and common myths:

• Risk factors: getting older, especially after 50; a mother, sister or other close relative with breast cancer; BRCA1 and BRCA2 gene changes; hormone replacement therapy; radiation to the chest earlier in life; and obesity, smoking, heavy drinking and inactivity.
• Steps that help: stay active (he suggested 30 minutes most days), keep a healthy weight, especially after menopause, eat plenty of fruits and vegetables, cut back on alcohol, breastfeed if you can, and talk with your doctor about the risks of hormone therapy.
• Myths to drop: men can get breast cancer too, although it is rare; most lumps are not cancer; most people diagnosed have no family history of it; and there is no scientific evidence that wearing a bra, including an underwire, causes breast cancer.

More from Dr. Cooper on breast health

Frequently asked questions

Should I still do monthly breast self-exams?

Organizations differ. Dr. Johnson and many breast surgeons still recommend them. The American Cancer Society says self-exams are not sufficient for screening but that women should know how their breasts normally look and feel. Either way, have any change checked and keep up with your mammograms.

When should I start getting mammograms?

The U.S. Preventive Services Task Force recommends a mammogram every 2 years from age 40 to 74. The American Cancer Society gives women the option to start yearly at 40, recommends yearly mammograms from 45 to 54, and every one or two years from 55. Women at higher risk may need to start earlier and add MRI. Ask your doctor which schedule fits you.

What does it mean if I am called back after a mammogram?

Usually that the radiologist wants a closer look, often with an ultrasound or more mammogram views. Callbacks are fairly common, and fewer than 1 in 10 women called back for more tests are found to have cancer.

What are dense breasts?

Breasts with more fibrous and glandular tissue than fatty tissue. Dense tissue can make cancer harder to see on a mammogram. Your mammography facility must tell you whether your breasts are dense; ask your doctor whether more imaging makes sense for you.

Is a lumpectomy as effective as a mastectomy?

For early-stage breast cancer, the American Cancer Society says the chance of survival is the same with breast-conserving surgery plus radiation as with mastectomy. The right choice depends on the size and spread of the cancer, your genetics and your own preferences.

Can men get breast cancer?

Yes, although it is rare. The American Cancer Society says fewer than 1% of breast cancers in the U.S. occur in men. Men should also get any breast lump checked.

Sources

1. Double Dose with the Coopers, Episode 03, Part 01 and Part 02 (YouTube, October 21, 2026), the clips posted October 21 and October 22, 2026, and Dr. Cooper’s breast health shorts from November 2024.
2. American Cancer Society. Recommendations for the Early Detection of Breast Cancer.
3. American Cancer Society. Signs and Symptoms of Breast Cancer.
4. American Cancer Society. Getting Called Back After a Mammogram.
5. American Cancer Society. Breast-conserving Surgery (Lumpectomy).
6. American Cancer Society. Breast Cancer Death Rates Are Highest for Black Women, Again (2022).
7. American Cancer Society. Key Statistics for Breast Cancer in Men.
8. U.S. Preventive Services Task Force. Breast Cancer: Screening (2024).
9. National Cancer Institute. Breast Cancer Screening (PDQ), patient version.
10. U.S. Food and Drug Administration. Important Information: Final Rule to Amend the Mammography Quality Standards Act (MQSA).

Guidance quoted from these organizations was checked on October 26, 2026.