Breast Self-Examination (BSE)

Why should one do BSE?

There is a 1 in 10 chance that a woman will have breast cancer during her lifetime. Over 1,000,000 women find lumps in their breasts every year some of which are cancerous but most are benign. A simple Breast Self-Examination (BSE) can be the key to finding any abnormality early.

Statistics about breast cancer

• Approximately 25% of breast cancers will result in death.
  
• Breast cancer is the second most common cancer found in women (following uterus cancer).
  
• If diagnosed and treated early, almost 95% of all breast cancers can be cured. That's why the BSE is so important.
  

Risk factors

There are several risk factors that will determine how likely you are to have breast cancer:

Age: It is rare for women younger than 35 to have breast cancer. The risk increases with age. Most breast cancers occur in women older than 50 years.

Family history: If your mother, sister, or daughter has developed breast cancer before menopause, you are three times more likely to develop the disease.

Personal history: If you've had breast cancer, you have an increased risk of getting it again. Also, if you've had benign breast disease (e.g., fibrocystic breast disease), you are at an increased risk.

The following also put you at greater risk:

• If you began menstruating early (before age 12)
• If you take birth control pills (though evidence is not conclusive)
• If you never have children
• If you have not breast-fed your children
• If you have children when you are 30 or older
• If you have menopause at 55 or later
• If you take Hormone Replacement Therapy (HRT).
  

Most of these risk factors involve your level of oestrogen. Higher oestrogen levels are strongly linked with susceptibility to breast cancer.

Lifestyle: There is a lower incidence of breast cancer among women who exercise regularly and a higher proportion of breast cancer among obese women. There is also evidence that there is increased risk of breast cancer with increased alcohol use (i.e., 3 or more drinks per week).

Who should do BSE?

It is good to be in the habit of breast self-examination (BSE) on a regular basis since early detection leads to early investigation and treatment. Women of all ages should perform self-examination since breast problems can occur at any age. The best time of the month to perform self-examination is after menstruation, when the breast tissue is softer and lumps are more likely to be felt. Immediately prior to menstruation the breast becomes naturally lumpy and often tender - features that can mask a problem. For women who are post-menstrual, with irregular periods or who have had hysterectomy, a suitable time should be chosen - for example the 1st day of the month. Examination more frequently than this, is probably not necessary and may lead to increased anxiety. A woman who regularly examines her breasts will get a very clear idea of her normal breast texture and consistency, and will help her to notice if something is different. Individual hospitals and specialists may advise slightly different methods, but the principles of BSE are the same.

How to do BSE?

There are two basic steps to conducting a BSE:

1. Visual Examination
   
2. Tactile Examination

Visual Examination

During the first part of the BSE, the visual examination, you look for changes in each breast. What is important in visual BSE is not the normal difference between your two breasts, but any change in one breast without a similar change in the other. The changes you have to look for include:

• Shape
  
• Size
  
• Contour or symmetry (is there a difference in the level between your nipples? Do both breasts look symmetrical?)
  
• Skin discoloration or dimpling
  
• Bumps/lumps – NOTE: normal lumpiness, like in the week before and of your menstrual cycle, will appear as very small and separate lumps like the texture of an orange.
  
• Sores or scaly skin
  
• Discharge or puckering of the nipple
  
• Dimple
  
• Ulceration
  
  

Stand in front of a mirror and look for the above changes in your breasts (from both a frontal and profile view) in 3 different positions:

1. With your arms raised
2. With your arms down at your sides
3. Bending forward
   
   

• with your hands on your hips and shoulders turned in
• with your arms relaxed hanging in front of you
  
  

Tactile Examination

This is the part of the examination when you need to feel your breasts for any changes. It is important to check the surrounding areas because breast cancer may be found in the lymph node tissue around the breast and underarm. Begin by lying in bed. Place a small pillow or folded towel under your left shoulder and your left hand behind your head. Your shoulder should be raised high enough for your left breast to be center on top of your chest, falling neither to the center nor toward the armpit; this arrangement distributes the breast tissue as evenly as possible across the chest wall. If a breast is not properly flattened against the chest, it is difficult to feel a lump – particularly in the outer upper quadrant, where tissue is thickest (and where most cancers occur).Feel your breasts and surrounding areas, which include:

• the breast
  
• between the breast and underarm
  
• the underarm
  
• the area above the breast up to the collarbone and across to your shoulder
  
  

Use the pads (where your fingerprints are) of your three middle fingers on your right hand pressed together flat to check your left breast, and do the opposite for the right breast. You should press on your breast with varying degrees of pressure:

• light (move the skin without moving the tissue underneath)
• medium (midway into the tissue)
  
• hard (down to the ribs "on the verge of pain")
  
  

When using any of the 3 patterns, you should always be using a circular rubbing motion without lifting your fingers.

Patterns of breast examination

Spiral: Begin with a large circle around the perimeter of your breast and make smaller and smaller circles as you work your way toward the nipple.

Wedges: Pretend your breast is divided into sections like triangular pieces of a cake, begin in the nipple area and feel your breast in a small circular motion within one section, then move on to the next wedge starting in the nipple area again.

Vertical or linear: Pretend your breast is divided into vertical stripes. Begin on the underarm area on one side and feel your breast in a small circular motion up and down in a zig zag pattern till the whole breast is covered. Then repeat the process for the right breast with your left hand.

What to feel for?

Carefully notice the "feel" of your normal breast structure, so that you can note at once any changes from what is usual for you. Many women have a normal thickening or ridge of firm tissue under the lower curve of the breast, at its attachment to the chest wall; also the large milk ducts can be felt as a ring of bumps at the outer edge of the areola. In very slender women, the bony prominences of the chest wall may be mistaken for chest tumours, as may enlarged milk glands, fat tumours, lymph nodes, or benign cysts. All such thickenings should be felt carefully during each monthly BSE, in order to distinguish normal conditions from potentially dangerous changes. Any lump or other change found in one breast only (especially in the upper outer quadrant) is more likely to be serious. If in doubt about ANY development, consult your doctor.

In the shower

Many lumps are more easily felt when the breast and fingers are wet and slippery with soap lather, which reduces the friction. If your breasts are small, place one hand on your head and examine the breast on the side with your opposite had in an up-and-down pattern, as you do lying in bed. If your breasts are large or pendulous, you will be better able to feel them if you immobilize a breast with one hand (first supporting from below, then pressing down from above) and examine it with the other hand (first from above, and then from below).

If you find that you exhibit any of the characteristics as described above, do not delay. Go see your physician immediately for a clinical breast examination and other tests for a definite diagnosis.