Breast self-examination
Encyclopedia
Breast self-examination (BSE) is a screening method
used in an attempt to detect early breast cancer
. The method involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling.
BSE was once promoted heavily as a means of finding cancer at a more curable stage, but large randomized controlled studies found that it was not effective in preventing death, and actually caused harm through needless biopsies and surgery.
Breast awareness is an informal alternative to structured breast self-examinations.
in the Cochrane Collaboration
, two large trials in Russia and Shanghai found no beneficial effects of screening by breast self-examination "but do suggest increased harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed." They concluded, "At present, screening by breast self-examination or physical examination cannot be recommended."
Although breast self-examination increases the number of biopsies performed on women, and thus revenue for the breast cancer industry, it does not reduce mortality from breast cancer. In a large clinical trial involving more than 260,000 female Chinese factory workers, half were carefully taught by nurses at their factories to perform monthly breast self-exam, and the other half were not. The women taught self-exam detected more benign (normal or harmless lumps) or early-stage breast disease, but equal numbers of women died from breast cancer in each group.
Because breast self-exam is not proven to save lives, it is no longer routinely recommended by health authorities for general use. It may be appropriate in women who have a particularly high risk of developing breast cancer. Some charitable organizations, whose donations depend on promoting fear of breast cancer, still promote this technique as a one-size-fits-all, universal screening approach, even in the low-risk women who are most likely to be harmed by unnecessary invasive follow-up procedures. Among groups promoting evidence-based medicine
, awareness of breast health and familiarity with one's own body is typically promoted instead of self-exams.
Breast self-examinations are based on an incorrect theory of cancer development, which assumes steady growth of the tumor. According to breast cancer specialist Susan Love
, "Breast cancer doesn't work like that...it's sneaky. You could examine yourself every day and suddenly find a walnut."
Among women with high-risk BRCA mutation
s, about 10% said that performing breast self-examination increased their anxiety. Others felt that it gave them a sense of control.
Learning breast self-examination increases a woman's level of depression, worrying, and anxiety about breast cancer. Greater anxiety about breast cancer is associated with a higher likelihood of performing breast self-examination. Women are also more likely to perform breast self-examination if they have experienced a false positive error from screening mammography (being wrongly told that breast cancer may be present, when the woman is actually cancer-free).
A variety of methods and patterns are used in breast self-exams. Most methods suggest that the woman stand in front of a mirror with the torso exposed to view. She looks in the mirror for visual signs of dimpling, swelling, or redness on or near the breasts. This is usually repeated in several positions, such as while having hands on the hips, and then again with arms held overhead.
The woman then palpates her breasts with the pads of her fingers to feel for lumps (either superficial or deeper in tissue) or soreness. There are several common patterns, which are designed to ensure complete coverage. 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. Some guidelines suggest mentally dividing the breast into four quadrants and checking each quadrant separately. The palpation process covers the entire breast, including the "axillary tail" of each breast that extends toward the axilla (armpit). This is usually done once while standing in front of the mirror and again while lying down.
Finally, women that are not breastfeeding
gently squeeze each nipple to check for any discharge
.
Various mnemonic devices are used as teaching devices. One is called the seven P's of BSE, after seven steps that are named to have the same first initial: Positions, Perimeter, Palpation, Pressure, Pattern, Practice, and Planning what to do if a change is found in the breast tissue.
For pre-menopausal
women, most methods suggest that the self-exam be performed at the same stage of the woman's menstrual cycle
, because the normal hormone fluctuations can cause changes in the breasts. The most commonly recommended time is just after the end of menstruation
, because the breasts are least likely to be swollen and tender at this time. Women who are postmenopausal or have irregular cycles might do a self-exam once a month regardless of their menstrual cycle.
Breast cancer screening
Breast cancer screening refers to the medical screening of asymptomatic, apparently healthy women for breast cancer in an attempt to achieve an earlier diagnosis. The assumption is that early detection will improve outcomes...
used in an attempt to detect early breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
. The method involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling.
BSE was once promoted heavily as a means of finding cancer at a more curable stage, but large randomized controlled studies found that it was not effective in preventing death, and actually caused harm through needless biopsies and surgery.
Breast awareness is an informal alternative to structured breast self-examinations.
Limitations
According to a meta-analysisMeta-analysis
In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...
in the Cochrane Collaboration
Cochrane Collaboration
The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...
, two large trials in Russia and Shanghai found no beneficial effects of screening by breast self-examination "but do suggest increased harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed." They concluded, "At present, screening by breast self-examination or physical examination cannot be recommended."
Although breast self-examination increases the number of biopsies performed on women, and thus revenue for the breast cancer industry, it does not reduce mortality from breast cancer. In a large clinical trial involving more than 260,000 female Chinese factory workers, half were carefully taught by nurses at their factories to perform monthly breast self-exam, and the other half were not. The women taught self-exam detected more benign (normal or harmless lumps) or early-stage breast disease, but equal numbers of women died from breast cancer in each group.
Because breast self-exam is not proven to save lives, it is no longer routinely recommended by health authorities for general use. It may be appropriate in women who have a particularly high risk of developing breast cancer. Some charitable organizations, whose donations depend on promoting fear of breast cancer, still promote this technique as a one-size-fits-all, universal screening approach, even in the low-risk women who are most likely to be harmed by unnecessary invasive follow-up procedures. Among groups promoting evidence-based medicine
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
, awareness of breast health and familiarity with one's own body is typically promoted instead of self-exams.
Breast self-examinations are based on an incorrect theory of cancer development, which assumes steady growth of the tumor. According to breast cancer specialist Susan Love
Susan Love
Dr. Susan Love is an American surgeon, a prominent advocate of preventative breast cancer research, and author.She is the president of the Dr. Susan Love Research Foundation, a non-profit organization that promotes and funds breast cancer intraductal research, and has a close involvement with the...
, "Breast cancer doesn't work like that...it's sneaky. You could examine yourself every day and suddenly find a walnut."
Among women with high-risk BRCA mutation
BRCA mutation
A BRCA mutation is a mutation in either of the genes BRCA1 and BRCA2. Harmful mutations in these genes produce a hereditary breast-ovarian cancer syndrome in affected families...
s, about 10% said that performing breast self-examination increased their anxiety. Others felt that it gave them a sense of control.
Learning breast self-examination increases a woman's level of depression, worrying, and anxiety about breast cancer. Greater anxiety about breast cancer is associated with a higher likelihood of performing breast self-examination. Women are also more likely to perform breast self-examination if they have experienced a false positive error from screening mammography (being wrongly told that breast cancer may be present, when the woman is actually cancer-free).
Methods
The woman then palpates her breasts with the pads of her fingers to feel for lumps (either superficial or deeper in tissue) or soreness. There are several common patterns, which are designed to ensure complete coverage. 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. Some guidelines suggest mentally dividing the breast into four quadrants and checking each quadrant separately. The palpation process covers the entire breast, including the "axillary tail" of each breast that extends toward the axilla (armpit). This is usually done once while standing in front of the mirror and again while lying down.
Finally, women that are not breastfeeding
Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
gently squeeze each nipple to check for any discharge
Nipple discharge
Nipple discharge is the release of fluid from the nipples of the breasts. Although it is considered normal in a wide variety of circumstances it is the third major reason involving the breasts for which women seek medical attention, after breast lumps and breast pain. It is also known to occur in...
.
Various mnemonic devices are used as teaching devices. One is called the seven P's of BSE, after seven steps that are named to have the same first initial: Positions, Perimeter, Palpation, Pressure, Pattern, Practice, and Planning what to do if a change is found in the breast tissue.
For pre-menopausal
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
women, most methods suggest that the self-exam be performed at the same stage of the woman's menstrual cycle
Menstrual cycle
The menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human menstrual cycle....
, because the normal hormone fluctuations can cause changes in the breasts. The most commonly recommended time is just after the end of menstruation
Menstruation
Menstruation is the shedding of the uterine lining . It occurs on a regular basis in sexually reproductive-age females of certain mammal species. This article focuses on human menstruation.-Overview:...
, because the breasts are least likely to be swollen and tender at this time. Women who are postmenopausal or have irregular cycles might do a self-exam once a month regardless of their menstrual cycle.