A course about breast self examination
Description
Breast self examination is the best method available for detecting any abnormalities in either
breast, especially findings that may indicate breast cancer. A woman who knows the texture and feels
her own breast is far more likely to detect changes that develop. Thus it is important for a woman to
develop the habit of doing breast self exam as early as possible. This technique would involve complete
physical examination of the breast.
In this module, there will be a discussion about Breast self examination. It will answer the
questions what or the meaning of BSE, why to conduct such examination or its importance, when would
be the most appropriate time to conduct it and how many times should BSE done, where would be the
suitable place to conduct it, who should do BSE and how to perform the examination and in the last part
of the module, an evaluation tool was prepared to examine how well the learner improved his/her BSE
skills.
The audience for this module would probably be nursing students, nurses, clinical instructors and
other health care practitioners so that they would know how to conduct health education conferences
about breast self exam properly to women in the community. This module will also be useful for nurses
or any health service provider who are working at the delivery room. This can be a routine activity at the
delivery room for all clients to prevent occurrence of complications of diseases and early treatment. This
would enhance the nurses’ strategies on how to discuss BSE and its other components.
Objectives
After the course of this module, the audience should be able to:
1. Define what is breast self examination
2. Enumerate the purpose and importance of BSE
3. Demonstrate the proper steps on how to do BSE
4. Know the indications and how regular should BSE done
5. Practice safe and quality nursing care to clients
6. Provide privacy to clients
7. Improve their communication skills in dealing with clients
8. Conduct health education sessions properly
Duration
3 hours
Methodologies and Learning strategies:
1. Discussion
2. Return Demonstration
Content
This module would integrate safe and quality nursing care as the main core competency involve.
It actually ensures safety and comfort of the patient all throughout the procedure. In the first part of the
examination, privacy of the client is being reminded because it would involve exposure of the breasts. It
performs complete and systematic nursing assessment of the breast as a way to prevent further
complications of such a disease example is the breast cancer. Early diagnosis of a disease could save a
life because early treatment could be given.
This module is also more on communication skills and so it would also assimilate the second core
competency which is communication. Before the procedure an establishment of rapport with client
should be given prioritize because without this, the client would not trust the nurse and they could not
also participate. Significant others are also important for communication because they are considered as
secondary source of information which may also be relevant to the client’s condition. Verbal and non
verbal cues are important in breast self exam because it may show signs of diseases such as pain
verbalizations and facial expressions. Explaining the procedure to the client is also important for the
client to understand its importance.
Health education would also be one of its core competencies. Philippines is already Asia’s highest
incidence rate for breast cancer. We lack early diagnosis of the disease and so information dissemination
is also lacking. Health education about breast self exam is vital for early recognition of diseases of the
breasts.
I. What is Breast Self Examination?
It is a screening method used to detect early breast cancer. The method entails complete
assessment of breast for possible lumps, distortions or swelling.
The 7 P’s of Breast Self Examination (BSE)
1. Position: Inspect breasts visually and palpate in the mirror with arms at various positions. Then
perform the examination lying down, first with a pillow under one shoulder, then with a pillow
under the other shoulder, and finally lying flat.
2. Perimeter: Examine the entire breast, including the nipple, the axillary tail that extends into the
armpit, and nearby lymph nodes.
3. Palpation: Palpate with the pads of the fingers, without lifting the fingers as they move across
the breast.
4. Pressure: First palpate with light pressure, then palpate with moderate pressure, and finally
palpate with firm pressure.
5. Pattern: There are several examination patterns, and each woman should use the one which is
most comfortable for her. The vertical strip pattern involves moving the fingers up and down
over the breast. The pie-wedge pattern starts at the nipple and moves outward. The circular
pattern involves moving the fingers in concentric circles from the nipple outward.
6. Practice: Let client practice the breast self-exam and become familiar with the feel of the breast
tissue, so client can recognize changes.
7. Plan: Know what to do if client suspect a change in their breast tissue. Know client’s family
history of breast cancer. Instruct client for mammography done as often as the health care
provider recommends.
Signs of a Problem
If the client notices any of these symptoms during breast self-exam, instruct her to call doctor:
• A lump
• Swelling
• Skin irritation
• Dimpling
• Pain
• Nipple retraction (nipple turns in)
• Redness of nipple or breast skin
• Scaly nipple or breast skin
• Nipple discharge
Any lump should be checked right away. Tests may be needed. In some cases, a biopsy may be
done to look at the tissue.
Process
Looking
The self-exam should always be done in good light.
Stand or sit in front of a mirror. Instruct client to place
arms at their sides. Look for dimpling, puckering, or
redness of the breast skin, discharge from the nipples,
or changes in breast size or shape. Encourage them to
look for the same signs with their hands pressed tightly
on your hips and then with their arms raised high.
Feeling
Lie flat on bed. Place a folded towel or a pillow under
their left shoulder. Place their left hand under or over
their head. They also can feel for changes when they
are standing.
With their right hand, keeping the fingers flat and together, instruct them to gently feel their left breast
without pressing too hard. They can use one of the three methods below. Then lower their right arm and
do the exam on the other breast.
Choose one of these methods
Circle. Circle. Instruct them to begin at the top of their breast and
let them move their fingers slowly around the outside in a large
circle. When they return to the top, move their hand a little closer
to the nipple and make a smaller circle. Let them do this in smaller
and smaller circles until they have examined all of the breast tissue.
Lines. Begin in the underarm area. Instruct them to slowly move
their fingers down until these fingers are below their breast. Let
them move their fingers closer toward their nipple and go slowly
back up, using the same motion. Use this up-and-down pattern all
the way across their breast.
Wedge. Initiate them to begin at the outside edge of their breast.
Coach them to slowly work their way in toward the nipple, doing one wedge-shaped section at a time.
Let them do this until the entire breast area has been examined.
II. When should breast self examination perform and how frequent should BSE
done?
Women should be instructed to do breast self-examination monthly so that clients become familiar with
the usual appearance and feel of their own breasts. The best time to do BSE is 2 or 3 days after the
client’s menstrual period, when the breasts are least likely to be tender or swollen. A woman who no
longer has periods may find it helpful to pick a particular day, such as the first day of the month, to
remind her that it is time to do BSE.
III. Who should do Breast self exam?
Women older than 20 years should perform monthly breast self-examinations and between the
ages 20-39 should have physical examination of the breast by a health professional every 3 years.
IV. Where should Breast self exam done and what are the equipments needed?
BSE can be done in a room comfortable for the client. Privacy should be implemented all throughout
the procedure.
These are the things needed in the room:
1. Patient gown with drape
2. Mirror
3. Examining table or bed
4. Pillow
5. Written materials for documentation
V. Why Breast self examination is important?
Breast self examination is a useful tool for early detection of breast cancer. BSE can help women
detect cysts or other benign (noncancerous) breast problems between checkups. Although it might
seem inconvenient at first, BSE is a skill that clients can use throughout her life to help ensure good
breast health.
Breast Self Exam
(Evaluation tool)
Ratings:
5- Excellent
4- Very Satisfactory
3- Satisfactory
2- Fair
1- Needs improvement
Step Rationale 5 4 3 2 1 Remarks
1. Explain the For the client to
purpose of understand its importance
BSE
2. Create a warm, To motivate the client to
supportive incorporate the practice to
atmosphere personal routines
and focus on
open
discussion
3. Specify best Timing varies according to
time to the phase of woman’s life
complete and it is important to
examination remember the best time to
(one week promote effectiveness and
after each comfort.
menstrual
period when
breasts are not
tender or after
menopause,
women should
perform BSE
on the same
day each
month)
4. Instruct the Inspection is done in three
client to positions to detect any
inspect her change in size, symmetry,
breasts by shape, color, thickening, or
standing or surface appearance.
sitting in front
of a mirror in
three positions:
With both arms
relaxed at her sides
With both arms
stretched straight over
her head
With both hands
placed on her hips
while leaning forward
5. Advise the
client to note
the following:
a. Size and Breasts may vary but
symmetry variations should remain
constant during rest or
movement.
b. Shape and Should be rounded or
direction of pendulous and pointing
breast slightly lateral. Abnormal
contours or changes in size
may indicate mass
c. Color, Marked venous pattern
thickening, may indicate an increased
edema, and blood supply associated
venous with tumor and skin edema
patterns may indicate blocked
lymphatic drainage
d. Surface of Note for skin dumpling,
breasts puckering or retraction
(pulling) when the hands
are pressed together
e. Nipples Skin dimpling, pulling and
retraction may indicate an
underlying tumor mass.
Nipple discharge may be
normal for breastfeeding
but may also suggest
malignancy
6. After she
inspects her
breasts,
instruct her to
palpate them
as follows:
Lie down. Place one
hand behind your
head. With the other
hand, fingers flattened
gently feel your
breasts. Press lightly
Check the breasts.
Begin with the outer
portion of the breasts
following a clockwise
manner, gradually
working your way to
the center of each
breast, feeling gently
but firmly for lump.
Repeat the process on
the other breast
Sit up and repeat the
palpation with your
hand behind your
head.
7. Instruct client
to end the
palpation of
each breast by
squeezing the
nipple between
her thumb and
index finger.
She should
note
characteristics
of any
discharge.
8. Provide
information
about warning
signs of breast
cancer and
what should do
if she
identifies any
of these.
9. Provide client
with a
reminder
symbol for
monthly BSE.
