Breast Self Examination (BSE) can be performed during assessment of the female breast as part of physical examination; it can be taught in any setting, either to individuals or groups. Instructions about breast self examination are provided to
men if they have a family history of breast cancer because these men may be at higher risk for male breast cancer.
Variations in breast tissue occur during the menstrual cycle, pregnancy, and menopause. Therefore, normal changes must be distinguished from those that may signal disease. Most women notice increased tenderness and lumpiness before their menstrual period; therefore, breast self examination is best performed after menses (day 5 to day 7, counting the first day of menses as day 1), when less fluid is retained.
Younger women, who have normal lumps in their breasts, find it particularly difficult to perform breast self exam because they have a harder time distinguishing normal from abnormal lumps and are not sure of what they are feeling due to the density of their breast tissue.
Even women who perform breast self examination may delay seeking medical attention because of fear, economic factors, lack of education, reluctance to act if no pain is involved, psychological factors, and modesty. Women should begin practicing breast self examination at the time of their first gynecologic examination, which usually occurs in their late teens or early 20s. All health care providers, aware of these implications, should encourage women to examine their own breasts and teach them to recognize early changes that may indicate problems. The nurse plays a pivotal role in preventive education.
Almost all settings lend themselves to teaching, providing information, and encouraging appropriate care for prevention, detection, and treatment of breast problems. An individual teaching session with the patient can increase the frequency with which she practices breast self examination.
How to perform breast self-examination
The best time to do a breast self-exam is a few days after your monthly menstrual cycle ends. Hormonal changes can affect the size and feel of your breasts, so it’s best to perform the exam when your breasts are in their normal state.
Women who don’t menstruate should choose a certain day to perform the exam, such as the first day of each month.
Start by standing topless in front of a mirror with your hands at your sides.
Visually inspect your breasts for the following:
- changes in size, shape, or symmetry
- inverted nipples
- asymmetrical ridges at the bottom
- Redness, soreness, rash, or swelling
Check for these signs;
With your hands at your sides
With your arms over your head
And again place hands on your hips and hunch over. While you’re at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood)
You can as well examine your breast by palpation by feeling your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter. Check out the steps below:
Lie down and roll on to your left side to examine your right breast. Place your right hand, palm up on your forehead. Your breast should lie as flat on your chest as possible. It may be easier and more comfortable if you put a pillow behind your shoulder or back.
Using the flat pads of your three middle fingers—not the tips—move the pads of your fingers in little circles, about the size of a dime. For each little circle, change the amount of pressure so you can feel ALL levels of your breast tissue. Make each circle three times—once light, once medium, and once deep—before you move on to the next area.
Start the circles in your armpit and move down to just below the bra line. Then slide your fingers over—just the width of one finger and move up again. Don’t lift your fingers from your breast as you move them to make sure you feel the entire area. Continue this up-and-down vertical strip pattern—from your collarbone to just below your bra line—until you reach the nipple.
Check the inner half of your right breast. When you reach the nipple, remove pillow and roll on to your back, remove your hand from your forehead and place this arm at a right angle (see drawing). Carefully check the nipple area using the same circular pressures as before, without squeezing. Then examine the remaining breast tissue using the up-and-down vertical strip pattern, until you reach the middle of your chest. Place your non-palpating hand down at your side, make a row of circles above and below your collarbone, working from your shoulder to your mid-line.
Roll on to your right side and repeat these steps on your left breast, using your right hand.
Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described above.
Risk for breast self examination
There’s no medical risk involved in a breast self-exam. Finding a lump in your breast can be alarming, but a majority of breast lumps aren’t malignant, or cancerous.
A lesson in breast self examination should include the following: optimal timing for breast self exam (5 to 7 days after menses begin for pre-menopausal women and once monthly for postmenopausal women), a demonstration of examination techniques, a review of what normal breast tissue feels like, a discussion on identification of breast changes, and a return demonstration on the patient and a breast model.
Patients who have had breast surgery for the treatment of breast cancer are carefully instructed to examine themselves for any nodules or changes in their breasts or along the chest wall that may indicate a recurrence of the disease.