Breast Self-Examination (BSE)

Objectives of Breast Self-Examination (BSE)

• Clarify confusion surrounding breast awareness and breast self-examination.
• Critique the evidence for breast awareness as a health promotion tool.

Introduction to Breast Cancer

• Breast cancer impacts over 240,000 new patients annually in the United States.
• A woman is diagnosed with breast cancer approximately every 3 minutes.
• Breast cancer claims a life approximately every 12 minutes.
• 70% of breast cancer cases occur in women with no identifiable risk factors.

Definition of Breast Self-Exam

• A breast self-exam is a check-up a woman does at home to look for changes or problems in the breast tissue.
• Many women consider BSEs to be important for their health.
• Experts disagree about the benefits of breast self-exams in finding breast cancer or saving lives.
• Individuals should talk to their healthcare provider about whether breast self-exams are right for them.

Statistics on Breast Cancer

• Approximately 40,600 deaths from breast cancer are expected next year (40,200 women, 400 men).
• Breast cancer is the second leading cause of cancer deaths in women.
• Breast cancer also affects a small percentage of men.
• An estimated 192,200 new invasive cases of breast cancer are expected among women in the United States this year.
• About 1,500 new cases of breast cancer are expected to be diagnosed in men next year.

Timing of Breast Self-Exam

• The best time to do a breast self-exam is right after your period, when breasts are not tender or swollen.
• If you do not have regular periods or sometimes skip a month, perform the exam on the same day every month.

Steps in Conducting a Breast Self-Exam (BSE)

• There are two basic steps: first, look at your breasts, and then touch them.

Visual Examination

• During the visual examination, look for changes in each breast.

Visual Examination Steps

• Stand in front of a mirror and look for changes in your breasts.
• Examine from frontal and profile views in 3 different positions.
• With your arms up behind your head.
• With your arms down at your sides.
• Bending forward.

Changes to look for during visual examination

• Size.
• Shape.
• Bumps/lumps.
• Normal lumpiness, like in the week before and during your menstrual cycle, will appear as very small and separate lumps, like the texture of an orange.
• Contour or symmetry; note any difference in the level between your nipples and whether breasts look symmetrical.
• Sores or scaly skin.
• Skin discoloration or dimpling.
• Discharge or puckering of the nipple.

Tactile Examination

• Begin by looking for changes while standing up.
• Some find it useful to do this part of the BSE in the shower because soap or bath gel will ease feeling your breasts.
• For the BSE, you need to pick a pattern to feel your breasts and surrounding areas.
• Examine the breast itself.
• Examine between the breast and underarm.
• Examine the underarm itself.
• Examine the area above the breast up to the collarbone and across to your shoulder.
• It is important to check surrounding areas because breast cancer may be found in the lymph node tissue around the breast and underarm.
• Use the pads of your three middle fingers on your right hand pressed together flat to check your left breast and vice-versa.
• You should press on your breast with varying degrees of pressure.
  • Light: move the skin without moving the tissue underneath.
  • Medium: midway into the tissue.
  • Hard: down to the ribs "on the verge of pain".

Palpation Patterns

• Spiral (concentric circles): Begin with a large circle around the perimeter of your breast and make smaller and smaller circles as you work your way toward the nipple.
• Pie shape wedges: Pretend your breast is divided into sections like pieces of a pie; begin in the nipple area and feel your breast in a small circular motion within one pie shape section, then move on to the next wedge starting in the nipple area again.
• When using any of the 3 patterns, you should always be using a circular rubbing motion (in dime-sized circles) without lifting up your fingers.
• After performing the tactile examination while standing up in front of a mirror, you should do the whole examination again while lying down.

Summary of BSE Procedure

• Put your left arm behind your head and use your right hand to examine your left breast.
• Put a small pillow or towel under your left shoulder to aid you.
• Use the pads of your 3 fingers of your right hand to check your left breast in the pattern of your choice (spiral, pie shape wedges, or up and down).
• Be sure to always use the same pattern; it's the best way to know if there are changes.