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Breast self-examination: A means to detect Breast Cancer earlier?



A woman examines her breast.

Breast cancer is a threatening disease among women. And, if not diagnosed or found earlier, it can most of time, lead to death. That is why, it’s important for women to undergo physical examinations and other diagnostic tests, most especially for those who are at an advance age and for those who are more likely to develop the deadly disease.

Diagnostic tests could be expensive, however, there is a way to find out breast cancer’s early signs and symptoms prior to a medical checkup. This method is called Breast self-examination, BSE or Self Breast Exam. But, before doing this procedure, learn more about BSE. Learn about the techniques applied, and know its advantages and disadvantages.

What is BSE?

Breast self-examination (BSE) is an easy but unreliable method for finding possible breast cancer.

If performed appropriately and regularly BSE may help in early detection of some types of breast cancers, although it should not substitute for screening methods (such as mammography) that have been proven to be effective. The method involves feeling breasts for possible distortions or swelling.

How to perform BSE?

The steps involved in self exam are:

  • Stand in front of a mirror with top exposed.
  • Place hands on hips.
  • Look for signs of dimpling, swelling, soreness, or redness in all parts of your breasts in the mirror.
  • Repeat with arms raised above your head.
  • While still standing, palpate your breasts with your fingers, feeling for lumps. Try to use a larger area of your fingers rather than prodding. Feel both for the area just beneath the skin and for the tissue deeper within. There are several common patterns, which are designed to ensure complete coverage. 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.
  • Go over the entire breast while examining. One method is to divide the breast into quadrants and palpate each quadrant carefully. Also examine the “axillary tail” of each breast that extends toward the axilla (armpit).
  • Repeat palpation while lying down.
  • Check the nipples and the area just beneath them. Gently squeeze each nipple to check for any discharge.

Various mnemonic devices are used as teaching devices. One is called the seven P’s of BSE, after seven steps that are named to have the same first initial: Positions, Perimeter, Palpation, Pressure, Pattern, Practice, and Planning what to do if a change is found in the breast tissue.

The Seven P’s method

A similar method of self-examination is known as the Seven P’s of BSE:

1. 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.
2. Perimeter: Examine the entire breast, including the nipple, the axillary tail that extends into the armpit, and nearby lymph nodes.
3. Palpation: Palpate with the pads of the fingers, without lifting the fingers as they move across the breast.
4. Pressure: First palpate with light pressure, then palpate with moderate pressure, and finally palpate with firm pressure.
5. 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.
6. 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.
7. 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.

About eight in ten lumps discovered by BSE are harmless. Nevertheless, any abnormality thus detected should immediately be reported to a doctor. Though most breast cancers are detected by women, BSE should be combined with an annual examination by a doctor for better chances of detection. Women can easily miss a breast lump that an expert can find. For the same reasons it is better to learn BSE from an expert.

It is not a replacement for more trustworthy techniques like mammography or an examination using MRI.

Limitations

According to a meta-analysis in the Cochrane Collaboration, two large trials found no beneficial effects of screening by breast self-examination “but do suggest increased harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed.” They concluded, “At present, screening by breast self-examination or physical examination cannot be recommended.”

Although breast self-examination increases the number of biopsies performed on women, it does not reduce mortality from breast cancer. In a large clinical trial, 132,979 female Chinese factory workers were taught by nurses at their factories to perform monthly breast self-exam, while 133,085 other workers were not taught self-exam. The women taught self-exam tended to detect more breast nodules than those in the control group. The women taught breast self-exam were mostly likely to detect benign or early-stage breast disease. It did not affect mortality.

Because breast self-exam does not save lives, it is no longer routinely recommended by any health authorities for general use. It may be appropriate in selected women. Awareness of breast health and familiarity with one’s own body is typically promoted instead of self-exams.

Video

BSE Tutorial Video.

References

1. Kösters JP, Gøtzsche PC. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003373. DOI: 10.1002/14651858.CD003373

2. Thomas DB, Gao DL, Ray RM, et al. (2002). “Randomized trial of breast self-examination in Shanghai: final results”. J. Natl. Cancer Inst. 94 (19): 1445–57. PMID 12359854.

3. Harris R, Kinsinger LS (2002). “Routinely teaching breast self-examination is dead. What does this mean?”. J. Natl. Cancer Inst. 94 (19): 1420–1. PMID 12359843.

4. Baxter N (June 2001). “Preventive health care, 2001 update: should women be routinely taught breast self-examination to screen for breast cancer?”. CMAJ 164 (13): 1837–46. PMID 11450279.

5. “eMedicineHealth, Breast Self-exam”

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