Self Breast Exam

1. See Also
   1. Breast Cancer Screening
   2. Breast Mass
   3. Breast Anatomy
2. Efficacy
   1. Study of 266,000 women in Shanghai, China
      1. Intervention: Intensive self exam instruction
      2. Control Group: Low Back Pain prevention instruction
      3. Results
         1. No difference in Breast Cancers identified
         2. Twice as many benign growths found in BSE group
      4. Interpretation
         1. Insufficient evidence to recommend for or against
      5. References
         1. Thomas (1997) J Natl Cancer Inst 89:355 [PubMed]
         2. Thomas (2002) J Natl Cancer Inst 94:1445-57 [PubMed]
   2. Meta-analysis findings consistent with Shanghai study
      1. SBE with no significant impact on mortality
      2. Increases the number of biopsies performed
      3. Hackshaw (2003) Br J Cancer 88:1047-53 [PubMed]
3. Precautions
   1. Self Breast Exam is no longer routinely recommended due to low efficacy (see above)
      1. Does not lead to decreased Breast Cancer mortality
      2. High risk of false positives
   2. Consider a Breast self-awareness protocol as an alternative
      1. Women 20 years and older recognize normal appearance and feel of their Breasts (without systematic self-exam)
      2. Women who find new Breast changes should seek prompt medical attention
      3. McCready (2005) J Clin Nurs 14(5): 570-8 [PubMed]
4. Timing
   1. Perform monthly Self Breast Exam after age 20 years
   2. Menstruating: Perform 7-10 days after Menses start
   3. No Menses: Perform on first day of each month
5. Step 1: Standing before mirror, observe both Breasts
   1. Abnormalities to look for in each position
      1. Nipple Discharge
      2. Redness
      3. Puckering
      4. Dimpling
      5. Scaling of skin
   2. Positions of observation
      1. Arms at side
      2. Hands on hips leaning slightly forward
      3. Hands clasped behind head
6. Step 2: Examine Breasts with fingers
   1. Abnormal findings
      1. New or different Breast Lumps from prior examination
   2. Technique
      1. Use arm opposite Breast for examination
      2. Raise arm on side of Breast being examined
      3. Use flat surface of three middle fingers
      4. Press fingers over each area in small circles
         1. First apply superficial pressure
         2. Next apply deep pressure
   3. Pattern
      1. Imagine Breast as a clock face (left Breast Example)
         1. Top of nipple to middle of collarbone: 12:00
         2. Left side of nipple to armpit (includes armpit)
         3. Bottom of nipple to underside of Breast: 6:00
         4. Right side of nipple to Breast bone (Sternum): 9:00
      2. Move fingers around Breast in full 360 degree sweep
         1. Start at 12:00 at nipple and circle clockwise
         2. Cover all areas of Breast
      3. High risk areas on which to concentrate
         1. Between Breast and armpit (upper outer quadrant)
   4. Positions for examination
      1. Standing in shower (apply warm soapy water to Breast)
      2. Lying down (apply lotion to Breast)
7. References
   1. Austoker (1994) BMJ 309:168-74 [PubMed]
   2. (1997) How to do a Breast Self-Examination, ACS