Breast self-examination (BSE)
Breast self-examination (BSE) is a method used by women to check their own breasts for any unusual changes or conditions that might indicate a breast disorder, especially breast cancer. Traditionally, it was advised that women aged twenty and older perform BSE monthly, accompanied by regular clinical breast examinations. However, in 2009, the US Preventive Services Task Force (USPSTF) recommended against teaching the practice due to concerns that it could lead to unnecessary medical procedures. Despite this, organizations like the American Cancer Society and the National Breast Cancer Foundation emphasize the importance of women becoming familiar with their breast health through either formal BSE or informal self-checks.
The self-examination process typically involves systematically checking the breasts for lumps, swellings, or any other unusual signs, using a specific technique that includes varying levels of pressure. Women are encouraged to perform BSE regularly, ideally after menstruation or at a consistent time each month. While BSE can help individuals notice changes early, it is associated with a relatively low accuracy rate compared to professional examinations. Recent recommendations suggest that women should focus on regular clinical screenings rather than relying solely on self-examinations for early detection of breast cancer.
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Breast self-examination (BSE)
DEFINITION: A breast self-examination (BSE) is performed by a woman on her own breasts to detect any unusual conditions or changes that may suggest the possibility of a breast disorder, and particularly breast cancer. In the past, it was recommended that all women age twenty and older conduct a BSE on a monthly basis, in addition to undergoing a clinical breast examination periodically, depending on age and state of health. In 2009, the US Preventive Services Task Force (USPSTF) discouraged teaching the practice, stating that harms such as patients subsequently receiving unnecessary imaging procedures and biopsies outweigh the benefit. The American Cancer Society, the American Society of Clinical Oncology, and Susan G. Komen for the Cure have since recommended women to become familiar with their breasts through either formal BSE or informal, periodic self-checks. Some organizations such as the National Breast Cancer Foundation maintain that monthly self-exams are still vitally important.
Cancers diagnosed:Breast cancer
Why performed: Breast self-examinations are performed by women on their own breasts to detect unusual swellings, lumps, thickenings, or other conditions that may suggest the possibility of a breast disorder, including breast cancer. It is believed that this examination can educate a woman about how her breasts feel normally and, if performed routinely, alert her to any sudden changes, thereby facilitating early detection of a precancerous or cancerous mass. Proponents of formal BSE recommend that it be performed every month at the same time (in relation to the menstrual cycle).
Patient preparation: It is recommended that the examination take place in the shower (where water smooths the skin and makes it easier to detect changes) or lying prone.
Steps of the procedure: Using the left hand to examine the right breast (and vice versa), the woman should, with fingers flat, move gently over every part of the breast in a systematic fashion (vertically up to down or circularly from well beyond the exterior margins inward), starting well above the top margin of the breast and beyond each right and left margin as well. The examination should be conducted three times using light, medium, and heavy pressure. Women should also visually inspect their breasts from all sides. Muscles should be both flexed and relaxed. Women should be particularly alert to any swellings, dimpling of the skin, “orange-peel” (peau d’orange) appearance, discoloration, changes in or discharges from the nipple, lumps no matter how small, or other unfamiliar signs.
After the procedure: If a woman detects a change in how her breasts or nipples feel, then she should promptly notify her health care provider for follow-up. Diagnostic tests such as ultrasounds and biopsies may be conducted.
Risks: The examination can lead to anxiety in some individuals and often gives false-positive results.
Results: Women who perform a self-exam may become familiar with their own breasts and may be able to report abnormalities much earlier than if they wait for an annual clinical examination or mammogram. However, the USPSTF reported in its 2009 recommendation statement that self-exams have an accuracy sensitivity of only 20 to 30 percent as compared to 40 percent when performed by a medical professional. In 2024, USPSTF dropped any mention of self-examination and instead recommended that women be professionally screened every other year beginning at age 40. Early detection of precancerous or cancerous tissue greatly increases not only early treatment but also survival rates; thus, routine clinical examinations, irrespective of self-examinations, are very valuable screening tools.
Bibliography
"Breast Cancer Early Detection." Cancer.org. Amer. Cancer Soc., 17 Sept. 2013. Web. 9 Sept. 2014.
"Breast Cancer: Risk Factors." Cancer.net. Amer. Soc. of Clinical Oncology, May 2014. Web. 9 Sept. 2014.
"Breast Self-Exam." National Breast Cancer Foundation. Natl. Breast Cancer Foundation, 2012. Web. 9 Sept. 2014.
Kösters, Jan Peters, and Peter C. Gøtzsche. "Regular Self-Examination or Clinical Examination for Early Detection of Breast Cancer (Review)." Cochrane Database Systematic Review 3 (2008): 1–20. PDF file.
“Recommendation: Breast Cancer: Screening - United States Preventive Services Taskforce.” U.S. Preventive Services Task Force, 30 Apr. 2024, www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening#fullrecommendationstart. Accessed 28 June 2024.