What do you, as a nurse, know about self-breast examination? If a patient asks you how and when to perform a self-breast examination, how would you respond? Do you feel comfortable with your own knowledge of self-breast examination enough to educate a patient? In a study published in the Journal of Clinical Nursing, it was discovered that of 192 primary health nurses, 86% practiced self-breast examinations. Of the 86%, only 18% performed proper technique (Soyer, Ciceklioglu, & Ceber, 2006). This information led to an educational program that educated primary health nurses on the proper way to perform self-breast examinations.
The current controversy over benefits of performing self-breast examinations and just simple breast awareness do not take into account the education individuals are given regarding self-breast examination. There is currently no study that demonstrates a group of individuals who have been taught the proper techniques of a self-breast examination. The techniques used in self-breast examinations alter the validity of the studies conducted. Self-breast examination will be of no benefit in early detection if it is done improperly, just as a mammogram would be of no benefit if a trained professional did not perform the screening. This is where the primary nurse's role has a great impact.
Assessing a patient's compliance of performing self-breast examinations should entail not only if she merely does the examination, but when she is doing them and how she is doing them. There is evidence-based practice that portrays the proper way to perform a self-breast examination. If you, as the primary nurse, are not educated on proper techniques of a self-breast examination, it is your responsibility to provide a resource to the patient that can properly demonstrate this.
Self-breast examination can be part of a key diagnostic plan in breast cancer prevention (O'Connor, 1996). For this screening tool to be effective, it is important for a woman to know what is normal for her. The most effective way to accomplish this is through consistency. One must be consistent in all factors that make up the self-breast examination. In the paragraphs to follow, the basics of a self-breast examination and the key elements involved will be explained. These elements should be addressed and demonstrated to patients to ensure comprehension. The nurse could offer a breast model for return demonstration by the patient to ease any uncertainties.
Women should be provided education on the proper way to do a self-breast examination. The first steps should include the ideal time of month to perform the examination. This time should be approximately 2 days after the end of the menstrual cycle. In postmenopausal women, it should be a time during the month that they will recall every month. The self-breast examination begins by facing a mirror and examining the physical appearance of the breasts. Ask questions such as, are the breasts symmetrical, is the color consistent in both breasts, is the nipple dimpled, and is there any rash or abnormalities that can be visualized. Raise arms one side at a time to examine the underarm region.
The next step in a thorough self-breast examination involves position. Performing your monthly breast examination involves being in the same position each month. If performing in a standing position, the shower is an example of this, place one hand behind your head. Utilize the other hand to examine the breast. The technique and pattern that one chooses is an individual preference. Three different techniques are utilized, the Circle motion, the Up and Down motion, and the Wedge. The American Cancer Society recommends the Up and Down motion (O'Connor, 1996; Figure 1).
The Circle technique requires the use of your finger pads, not finger tips, of the first three fingers. Palpate the breast tissue, using three different types of pressure. First palpate light, followed by medium pressure, and then complete the examination with firm pressure. Palpate from the nipple area outward in a circular pattern. Make sure to palpate the entire breast tissue, including into the underarm area. You are feeling for lumps, knots, or skin thickening.
The Up and Down technique involves doing your breast examination by utilizing the first three fingers of your hand and using the pads of your fingers to palpate all three types of pressure from the outside of the breast tissue to most inner side of the tissue. Palpate up the breast tissue and then back down until the entire breast tissue has been palpated. Complete the examination by moving the pads of the fingers up and down the underarm region continuing to utilize all three different types of pressure.
The Wedge technique involves using the pads of the first three fingers on your hand. Begin the examination in the nipple region. Palpate from the nipple outward, imagining the breast to be wedged in eight different sections. Walk the finger pads from the nipple to outmost region of the breast and then back up the breast toward the nipple, completing a wedge pattern. After the entire breast tissue is palpated using light, medium, and firm pressure, begin to palpate the underarm area for any lumps, bumps, or thickening.
Once the breast examination is completed on one side, proceed to the other breast, repeating all steps described previously. During the breast examination, it is important to pay close attention to detail. Become familiar with the tissue in your breasts. The familiarity will help detect any differences in the breast tissue in the following monthly breast examinations. This step is crucial in early self-detection of breast cancer (Kegeles, 1985). Do not forget to palpate the area from the breast tissue to the collar bone, including the upper chest area.
Examining the nipples on both breasts involves more than physical appearance. It requires you to firmly press the nipple area, feeling for lumps or thickening. The final step in nipple examination involves squeezing the nipple between two fingers to check for fluid leakage (O'Connor, 1996). Any fluid expressed should be reported to your physician. Any changes in the skin at the nipple or around the nipple should also be reported to your physician.
When performing self-breast examination, it is important to remember that most women have lumps or lumpy areas in their breasts. Of the lumps that are examined, only 20% of them turned out to be cancer. Women who are diagnosed with fibrocystic disease find it difficult to perform self-breast examinations. Fibrocystic breast disease is common in middle-age women and elderly women (Bateman, 2006). The disease involves changes in the fibrous breast tissue. Women with this benign breast disease have fibrous breast tissue changes around or during the menses, and at older age due to breakdown of fibrous breast tissue causing changes in the feel of the breast. Benign breast conditions may clinically feel like cancer and therefore are examined closely and through imaging. Fibrocystic breast may present with cyst-like structure or thickened nodularity (Bateman, 2006).
For some women, self-breast examinations induce worry due to the fibrous breast tissue that may be palpated. For this reason alone, why it is important to be consistent and follow all steps of a self-breast examination. This will educate women to normal breast tissue and what is abnormal to aide in early detection of breast cancer. Utilizing the tools of self-breast examination, yearly mammograms and clinical breast examinations, together with consistency, are the best protection in detecting early breast cancers.
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