The One Place You’re Probably Forgetting When You Do A Breast Check

Every year, about 264,000 women in the United States are diagnosed with breast cancer. The enormity of this number underscores the importance of understanding your personal risk, abiding by guidelines for screenings and being otherwise on alert for any early signs of the disease.

Although many cancer organizations have shifted their recommendations away from monthly breast self-exams, there’s still an emphasis on familiarizing yourself with what “normal” looks and feels like for your breasts. When you’re in the shower, getting dressed or relaxing on the couch, get in the habit of periodically inspecting the area so that you have a sense of what feels typical and can detect something new or abnormal.

But there’s one area women often overlook when doing these breast checks: the underarms.

“I think a lot of people forget because they don’t consider that part of the breast,” said Dr. Janet Yeh, assistant professor at NYU Grossman School of Medicine and site chief of breast surgical oncology at NYU Langone Hospital―Brooklyn. “It’s connected to the breast, so it’s important to check there. If you were to have breast cancer, it usually starts in the breast first and then spreads to the lymph nodes, but we’ve seen situations where it shows up in the armpits first or only there. It’s rare and unusual, but it definitely happens.”

Below, Yeh and other experts break down what happens with the underarm lymph nodes in these situations and the best way to check that area.

“The underarm area is referred to as the axilla,” said Dr. Alyssa Cubbison, an assistant professor of radiology at the Ohio State University Wexner Medical Center. “Lymph nodes are normal and supposed to be there ― they’re called the axillary lymph nodes.”

The lymph nodes play an important role in the body, which is why they can be a major part of cancer detection.

“When breast cancer spreads, it tends to spread through the nearby lymph nodes,” explained Dr. Arif Kamal, chief patient officer at the American Cancer Society. “Lymph nodes are the checkpoint systems for the highway where immune cells in the body travel. When that checkpoint area gets enlarged, meaning you feel a lymph node in your underarm area, it can signify that there’s something going on.”

Lymph nodes generally become enlarged when there’s an infection. For example, the lymph nodes in your neck can swell when you have an upper respiratory infection.

“Enlarged lymph nodes may feel like a larger pea or a small ball of sorts,” Kamal said. “If someone feels that in their underarm area, they should report that to their clinical team.”

Keep in mind that like lumps in the breast, an enlarged lymph node or lump in the underarm area isn’t necessarily a sign of something very serious, but you’ll need a professional to assess.

“There are many benign explanations for it,” Cubbison explained. “It could just be a lymph node plumping up trying to clear an infection, but one thing we worry about is also that cancer can cause an enlarged axillary lymph node. We want to make sure we’re not missing something like that, so if it feels new to you, we always advocate to get it checked out by your doctor.”

When it comes to inspecting the underarm area, doctors recommend the same sorts of techniques you use for your breasts. Use the pads of two fingers or your whole finger and palm area and do circular motions or wipes.

“Put your hand down on your hip like you’re doing a Wonder Woman pose,” Yeh advised. “That stretches out the pectoralis muscle and allows you to go in an feel the lymph nodes behind it. Feel for very firm or enlarged lymph nodes. You might feel something like a marble rolling around in there. If you notice anything new or different, let a professional know.”

Cubbison advised applying both superficial and deep amounts of pressure.

“As you palpate or feel the area, if you press too deep, you may miss some of the superficial lymph nodes you’re compressing down,” she explained. “If you press too lightly, you miss the deeper ones. So apply varying degrees of pressure, both soft and firm. Just make sure you include the whole area and use small motions.”

Just as the underarm isn’t commonly associated with breast cancer, there are other areas Kamal suggests including in your checks as well.

“What we should be paying attention to is not just the breast tissue itself, the superficial part, but also the underlying chest wall,” he said. “That would be slightly above the breast to where the clavicle or collarbone is. Also up into the lymph nodes into the neck. Pay attention to any abnormalities up into the neck and underarm as well.”

Remember that familiarizing yourself with your “normal” and doing regular checks is not for self-diagnosis. Don’t immediately panic if you do find something different. It may well be a matter of cyclical changes in the breast related to your menstrual cycle or aging. That’s for professionals to determine.

“It’s really a way to look for something that feels different than you’d be used to and to use that as an alarm, to bring up to your clinical team, for them to follow up,” Kamal explained. “Also it’s important to recognize that a self breast exam does not replace the need for regular mammography because a mammogram is going to see things with a lot more precision and accuracy than an exam done by a patient or physician.”