How to Perform a Self-Breast Examination
Breast self-examination (BSE) is a method of finding abnormalities of the breast, for early detection of breast cancer. The method involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling.
BSE was once promoted heavily as a means of finding cancer at a more curable stage, but randomized controlled studies found that it was not effective in preventing death, and actually caused harm through needless biopsies and surgery.
- The self-exam is performed by standing in front of a mirror with the torso exposed to view.
- The woman looks in the mirror for visual signs of dimpling, swelling, or redness on or near the breasts. This is usually repeated in several positions, such as while having hands on the hips, and then again with arms held overhead.
- The woman then palpates her breasts with the pads of her fingers to feel for lumps (either superficial or deeper in tissue) or soreness. To be effective, this process needs to cover the entire breast, including the “axillary tail” of each breast that extends toward the axilla (armpit). This is usually done once while standing in front of the mirror and again while lying down.
- Some guidelines suggest mentally dividing the breast into four quadrants and checking each quadrant separately. Finally, women that are not breastfeeding gently squeeze each nipple to check for any discharge.
The 7 P’s of Breast Self Examination (BSE)
- Position: Inspect breasts visually and palpate in the mirror with arms at various positions. Then perform the examination lying down, first with a pillow under one shoulder, then with a pillow under the other shoulder, and finally lying flat.
- Perimeter: Examine the entire breast, including the nipple, the axillary tail that extends into the armpit, and nearby lymph nodes.
- Palpation: Palpate with the pads of the fingers, without lifting the fingers as they move across the breast.
- Pressure: First palpate with light pressure, then palpate with moderate pressure, and finally palpate with firm pressure.
- Pattern: There are several examination patterns, and each woman should use the one which is most comfortable for her. The vertical strip pattern involves moving the fingers up and down over the breast. The pie-wedge pattern starts at the nipple and moves outward. The circular pattern involves moving the fingers in concentric circles from the nipple outward. Don’t forget to palpate into the axilla.
- Practice: Practice the breast self-exam and become familiar with the feel of the breast tissue, so you can recognize changes. A health care practitioner can provide feedback on your method.
- Plan: Know what to do if you suspect a change in your breast tissue. Know your family history of breast cancer. Have mammography done as often as your health care provider recommends.
For premenopausal women, BSE is best done at the same stage of their period every month to minimize changes due to the menstrual cycle. The recommended time is just after the end of the last period when the breasts are least likely to be swollen and tender. Older, menopausal women should do BSE once a month, perhaps on the first or last day of every month.
Nursing Care Plan for Breast Cancer