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Breast Self-Examination
The purpose of a breast self-examination (BSE) is to allow the
woman to become familiar with her breast tissue and to note any
changes in this tissue over time. The examiner should emphasize
that most breast abnormalities found on BSE are benign, but that
early detection of a mass by BSE may identify tumors at more treatable
stages and reduce the amount of surgery needed (Reichman).
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From Reichman BS: Textbook and atlas: clinical breast
examination and instruction of patients in breast self-examination.
In Wallis LA, ed: Textbook of women's health,
Philadelphia, 1998, Lippincott-Raven.
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BSE has the added benefit of allowing women to become more
aware of their bodies and take responsibility for their breast
health. Women should be taught how the breast changes with age
and during the menstrual cycle. The best time for a woman to
examine her breasts is at one of the following regular intervals:
- At the end of her menstrual cycle if she has them
- On the last day off hormones if she is receiving cyclic
hormone replacement therapy (HRT)
- On the first day of each month if she is postmenopausal
and not taking HRT (Wallis)
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From Reichman BS: Textbook and atlas: clinical breast
examination and instruction of patients in breast self-examination.
In Wallis LA, ed: Textbook of women's health, Philadelphia,
1998, Lippincott-Raven.
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This consistent timing may increase her ability to detect changes.
The BSE is performed with the woman sitting or standing and
then lying down. The woman should stand before a mirror to inspect
her breasts. Again, she should inspect with her hands at her
sides, then overhead, then on her hips. Palpation is best accomplished
with the woman in the bath or shower where her fingers will
glide easily over the breast tissue. She should be instructed
to use any pattern she chooses so that she covers all the breast
tissue, including the area from nipple to axilla. She should
also palpate her breasts when lying flat. In this position the
breast tissue is distributed more evenly on the chest wall making
palpation easier.
Although many women avoid BSE because of their fear of detecting
a lump, most lumps are not cancerous. Indeed, women should be
informed that the major purpose of BSE is to allow them to become
comfortable with the feel of their breasts (Carlson).
There are no good data suggesting that BSE as a solo screening
tool reduces mortality from breast cancer. Therefore, BSE should
be used as a low-stress, low-cost adjunct to other modalities.
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