Breast Self-Examination (BSE)

All women over 20 years of age should practice monthly breast self-examination (BSE). Regular and complete Breast Self-Examination can help you find changes in your breast that occur between clinical breast examinations (by a health professional) and mammogram.

Women should examine their breasts when they are least tender, usually seven days after the start of the menstrual period. Women who have entered menopause, are pregnant or breast feeding and women who have silicone implants, should continue to examine their breasts once a month. Breast feeding mothers should examine their breasts when all milk has been expressed.

If women discovers a lump or detects any changes, she should seek medical attention. Most women will not develop breast cancer and most breast changes are not cancerous.

Remember the seven P’s for a complete Breast Self-Examination:

1. Position
2. Perimeter
3. Palpation
4. Pressure
5. Pattern
6. Practice with Feedback
7. Plan of Action


1. POSITIONS

VISSUAL Inspection: Standing

In each position, look for changes in contour and shape of the breast, colour and texture from the nipples.

Palpation: Side-lying & Fat

Use your left hand to palpate the right breast, while holding your right arm at a right angle to the rib cage, with the elbow bent. Repeat the procedure on the other side. The side-lying position allows a women, especially one with the large breasts, to most effectively examine the outer half of the breast. A women with small breasts may need only the flat position.

Side–lying position:

Lie on the opposite side of the breast to be examined. Rotate the shoulder (on the same side as the breast to be examined) back to the flat surface.

Flat position:

Lie flat on your back with a pillow or folded towel under the shoulder of the breast to be examined.

2. PERITER

The examination area is bounded by a line which extends down from the middle of the armpit to just beneath the breast, continues across the bone, then moves up to and along the collar bone and back to the middle of the armpit. Most breast cancers occur in the upper outer area of the breast (shaded area below).

3. PALPATION WITH PADS OF THE FINGERS

Use the pads of three or four fingers to examine every inch of your breast tissue. Move your fingers in circles about the size of a coin.
Do not lift your fingers from your breast between palpations. You can use powder or lotion to help your fingers glide from one spot to the next.

4. PRESSURE

Use varying levels of pressure for each palpation, from light to deep, to examine the full thickness of your breast tissue. Using pressure will not injure the breast.

5. PATTERN OF SEARCH

Use one of the following search patterns to examine all your breast tissue. Palpate carefully examined from end to end. Women who have had any breast surgery should examine the entire area and the incision.

Vertical Strip:

Start in the armpit; proceed downwards to the lower boundary. Move a finger’s width towards the middle and continue palpating upward until you reach the collar bone. Repeat this until you have covered all breast the nipple and four strips after the nipple. You may need between 10 and 16 strips.
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Wedge:

Imagine your breast divided like the spokes of a wheel. Examine each separate segments, moving from the outside boundary, move over a finger’s width and repeat the procedure until you have covered al breast tissue. You may need between 10 and 16 segments.

Circle:

Imagine your breast as the face if a clock. Start at 12 o’clock and palpate along the boundary of each circle until you return to your starting point. Then move down a finger’s width and continue palpating in ever smaller circles until you reach the nipple. Depending on the size of your breast, you may need 8 to 10 circles.

Nipple Discharge:

Squeeze your nipples to check for discharge. Many women have a normal discharge.

Axillary Examination:

Examine the breast tissue that extends into your armpits while your arm is relaxed at your side.

6. PRACTICE WITH FEEDBACK

It is important that you perform Breast Self-Examination while your instructor watches to be sure you are doing it correctly. Practice your skills under supervision until you feel comfortable and confident.
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7. PLAN OF ACTION

Every women should have a personal breast health plan of action.

1. Schedule your clinical breast examination and mammogram as appropriate.
2. Do monthly Breast Self-Examination. Ask your health professional on your Breast Self-Examination skills.
3. Report any changes to your health care professional.

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