A GUIDE TO SELF BREAST EXAMINATION

EARLY DETECTION INCREASES SURVIVABILITY
*Although this page refers to women, breast cancer does occur in men as well at a much less frequency.
* This page was created for a group project on breast cancer education by the students of UCLA School of Medicine.




(Picture 1)
         Breast Cancer is the most common type of cancer among women in the US other than skin cancer. In general, cancer refers to uncontrolled or abnormal growth of cells which results in tumor formation. Benign tumors refer to those that have not spread, whereas malignant tumors refers to cancerous cells that have gained access and spread to adjacent tissues. It is important to note that with early detection, breast cancer curability is around 90%. The sustained reduction in breast cancer mortality since 1991 can be attributed to improved techniques and education and self-awareness. Therefore it is important for women to learn about  leading  healthy, cancer preventative lifestyles, early detection or screening methods, and to have regular checkups with their physician. A complete care includes breast self examination (BSE), clinical breast examination, and recommended mammography screenings.
        Regular breast self examination allows women to recognize normal breast appearance. Therefore, with regular self breast examination women develop the ability to detect any changes or lumps at a smaller size.  Women should not ignore any changes found during their exam.  It should be noted that not all lumps are indicative of cancer. Although four out of five lumps found were not benign (cancerous), the only way to have had determined this is through further testing.



VISUAL/WRITTEN GUIDES FOR BREAST SELF EXAMINATION
 

NBC 4 Your Health Guide
American Cancer Society BSE Guide

WHO?
 The ACS recommends that all women over 20 perform a BSE once a month. For women 20-40, a clinical breast exam (CBE)  should be performed every 3 years. For Women over forty, a CBE should be performed yearly.

WHEN?
* MENSTRUATING WOMEN: Seven days after period starts. Breasts least tender or swollen
*NO LONGER MENSTRUATING or PREGNANT: Pick a day (first day of the month) and remind yourself.
*BREASTFEEDING: Pick a day and examine breasts after the milk has been expressed- when the breasts are least enlarged.
*ON BIRTH CONTROL PILLS: Examine breasts each time you start a new package of pills-after one "cycle"

SYMPTOMS:
* A change in size or shape of the breast
*Nipple discharge or tenderness
*Nipple inversion
*Dimpling/Puckering of skin
*Pitting or ridges of skin, like the skin of an orange
*Early breast cancers do not cause pain.
*lump or thickening of tissue
   If a lump is found in one breast, feel the other breast in the same area. If the lump is at the same plce, or if a lump disappears after menstruation, it is probably normal. Lumps can also form due to cysts and fat accumulation.

PROCEDURE?
  Normal Breasts are influenced and changed by the menstrual cycle, pregnancy, menopause, the affects of medication or by taking birth control pills. It is normal to have breasts a little lumpy or not smooth. Therefore, the days chosen for BSEs are when the breasts are least tender or swollen. Both breasts are usually also not of the same size.
*Use good lighting and a big mirror.
A BSE has two general components: Visualization and Physical Examination
Visual procedures to look for visual changes/symptoms:
1.Stand with hands folded behind your head, and press your hands to tighten the chest muscles.
2.Place hands firmly on hips, and bow forward while tightening elbow.

To examine for lumps/masses:
* Lie flat on back. Raise left side by placing a folded towel under the left shoulder. Place your left hand over your head. Use your right hand to examine the left breast. Look at right hand image below.
*To examine, imagine the breast as a hand clock. Place your fingerpads at 1200 and move them in a gentle, but firm circular manner around the breast. Do not lift your fingers. Move one inch towards nipple and repeat process till the entire breast and auxillary area is covered. For other patterns, look at left hand image below.
*Gently squeeze the nipple to look for a discharge.
* Lie on back, and repeat process for the right breast using the left fingerpads.
* While in shower, raise right hand and use left hand finger pads (not fingertips) to examine the right breast using the circular motion described. Cover the entire breast. Do the same for the left side.
* Rest arm on a firm surface and use circular motion to examine the area between the breast and underarm area.

Visual Guides for BSE from the American Cancer Society

 LINK: American Cancer Society- Breast Cancer Resource Center

It is important to note that screening methods are not diagnostic, but indicative of a person's health. While BSE has not been shown to increase survival rates, the " major benefit appears to be the identification of tumors appropriate for conservative local therapy", i.e. those tumors that have not spread. Therefore, it is still important to perform BSEs regularly. However, a BSE should not replace the place of clinical breast examinations or mammography.



   REFERENCES

   NBC 4 Your Health : http://4.18.35.21/Breast_Cancer/Breast_Cancer/bcp.html
   WEB MD : http://my.webmd.com/content/article/3176.774
   Kaiser Permanente Healthwise Handbook
   Harrison's Online : Ch.82, 91
   CANCERNET, NIH : 1-800-4-CANCER  http://cancernet.nci.nih.gov/
 

Picture 1 from NCI's "Understanding Breast Changes --A Health Guide for All Women---


    LINKS
WEB MD Breast Cancer Discussion Forum
UCLA School Of Medicine
If you have any comments or suggestions please email me @ snarayan@ucla.edu