Breast self-exam

Definition

Breast self-examination (BSE) is a diagnostic technique regularly performed by a woman, independent from a physician, both by feeling for anything suspicious in her breasts and by observing any changes through the use of a mirror.

Purpose

BSE should be performed monthly in order to discover changes in breast tissue, discharge from the nipple, or the onset of pain in the breast area. While 80% of lumps are not cancerous, such discoveries can ultimately lead to the detection of breast cancer .

Precautions

BSE is an effective self-diagnostic procedure, but it must not take the place of having a mammogram and having a health care provider check the breasts for abnormal changes. Make sure to schedule an annual clinical breast examination with a licensed medical care provider to supplement the BSE.

Description

It is important that BSEs are performed routinely so that a woman knows what her breasts normally feel and look like, resulting in quicker identification of anything abnormal. Self-exams take less than five minutes to perform and should be done a few days after the end of menstruation. Women that menstruate irregularly should choose a day of the month that is easy to remember, such as the date of their birth, and perform the exams on the same day each month.

The first phase of the BSE is to disrobe and stand in front of a mirror, observing the breast area in four different positions. First, with the arms down to the sides, look at the color, shape, outline, and direction of the breasts and nipples, taking note of anything atypical. Then, press the hands on the hips in order to flex the chest muscles, making the same observations. Next, observe the breasts while leaning forward. Finally, raise the arms overhead and notice anything abnormal such as color changes, dimpling of the skin, or nipple discharge.

The second phase of the BSE is performed lying down. First, put a pillow under the right shoulder and place the right hand under the head so that the elbow is positioned at a 90-degree angle. This is done in order to flatten the breast as much as possible, making the examination easier and more effective.

Then, using the pads of the fingers of the left hand, press firmly around the breast using a small circular motion about the size of a penny. A small amount of lotion or petroleum jelly can make it easier to feel for lumps. Three types of pressure should be used. The first pressure should be enough to examine the surface, typically just to move the skin and feel for changes in the top layer of tissue. The second level of pressure is a deeper pressure, probing into the tissue. The final pressure level is applied deep into the breast tissue so that the rib cage can be felt and a minor amount of discomfort is experienced. Choose a comfortable pattern such as circles, lines, or wedges to make sure that the entire breast and armpit area are thoroughly examined with each level of pressure.

Finally, tenderly squeeze the area around the nipple and check for fluid discharge. After the right breast has been thoroughly examined, repeat the above steps on the left breast.

Although it is uncommon, forms of breast cancer can also occur in men. The breast self-exam can be modified to be effective for men. Men can utilize the visual exam and can also feel for any changes in the tissue.

Preparation

Since the patient performs BSE in the comfort of her own home, there are not many preparations that need to be made. The patient should remove any distractions that could interfere with the performance of a thorough exam. It is also advisable to disrobe and to use lotion or lubricant when palpating the breast area.

Aftercare

BSE is not an invasive procedure. Therefore there is not any significant aftercare that needs to take place. Individuals should simply remember to perform the exam monthly and inform their doctor of any changes.

Risks

There are no known risks associated with the breast self-exam as long as the individual schedules regular exams with a physician and immediately reports anything unusual.

Normal results

Patients who perform BSE regularly know what their breast tissue normally feels like. Typically, there will not be any detectable anomalies in their breast tissue, unless they carry out the exam just prior to menstruation or during pregnancy when breasts may seem more lumpy and tender. In these cases, it is likely that abnormal lumps and tenderness are not associated with cancerous tumors. However, if a woman finds anything that makes her uneasy, she should consult with her physician.

Abnormal results

Women should consult with their physician if they notice dimpling of the skin, any change in outline or shape of their breasts, unusual lumps, areas of thickening, or pain during the palpation of the breasts. If milky white or bloody discharge from the nipple is observed, then the patient should call the doctor. Generally, if there are any observations that make a person uneasy, it is advisable to contact a doctor.

Resources

OTHER

"An Ounce of Prevention…How to Do Self-Exams." Sister: Columbia University's Feminist Magazine April 2001. 27 June 2001 <http://www.columbia.edu/cu/sister/SelfExams.html>.

"Breast Self-Exam (BSE) Why, When and How." Breast Cancer Information Service April 2001. 29 June 2001 <http://trfn.clpgh.org/bcis/GeneralInfo/bse.html>

"Breast Self Examination: Your Key to Better Breast Health."Y-ME National Breast Cancer Organization April 2001. 27 June 2001 <http://www.y-me.org/images/breast_self_exam.pdf>.

"BSE Breast Self Examination." Info Breast Cancer April 2001. 27 June 2001 <http://www.infobreastcancer.cyberus.ca/bse2.htm>.

Sally C. McFarlane-Parrott

QUESTIONS TO ASK THE DOCTOR

• When should a mammogram be performed to complement the BSE?
• Do breast implants interfere with BSE?
• Do hormone supplements interfere with BSE?

KEY TERMS

Palpate

—Examination by feeling and touching with the hands.