BSE and PEB can be performed by non-physicians and physicians alike. Non-physicians can be non-health professionals (lay) and health professionals (physicians and allied medical professionals). Physicians can by non-breast specialists and breast specialists (usually general surgeons with subspecialty on breast wellness management).
As much as possible, the parameters for quality, completeness, and accuracy should be the same for both BSE and PEB, for alignment purpose, though expectations will be higher for those who are trained to do BSE and PEB, the expectations being highest with breast specialists.
The minimum targets of BSE and PEB are quality, completeness, and accuracy in the detection and recognition of early breast cancer.
In formulating the indicators for quality, completeness, and accuracy, simplicity, measurability, and attainability (SMA) should be considered.
Simplicity can be operationally defined as easy to understand, easy to perform the examination and easy to measure the outcome and impact
Measurability can be operationally defined as being quantifiable to facilitate assessment of quality, completeness, and accuracy
Attainability can be operationally defined as being realistic in targets and doability.
Under the assumption that BSE and PEB shall be used as a tool to promote early detection and recognition of breast cancer, a personally recommended realistic target at present is 90% of the people who practice BSE and PEB based on recommended guidelines shall have a palpable breast cancer detected and recognized at a size not more 2 finger breaths (about 2-3 cm). Note: hopefully, in the future, the target size can be brought down to NOT more than 1 finger breath (about 1 -1.5 cm).
QI. What constitutes a complete breast self-examination? A complete physical examination of the breast?
“Complete” shall be operationally defined as “complete” using the following indicators:
Visual inspection AND palpation done.
Minimum essential parts of the body that should be covered in the examination (breast proper and armpits).
Areas of the parts of the body to be examined (entire areas of the breasts and armpits).
Thus, the minimum essential parts of the body that should be covered in a complete breast self-examination and physical examination of the breast are the breast proper and the armpits. The entire areas of the breast proper and the armpits should be covered in the second indicator of complete examination.
Examination of the supraclavicular area and other areas of the body can be done as indicated. However, the supraclavicular area is NOT included in the minimum essential parts that should be covered because the usual telltale signs of breast cancer are a palpable breast mass with or without a palpable axillary lymph node, usually NOT a supraclavicular mass.
Assessment of the formulated indicators:
Are they simple? Can at least 90% of the people committed to follow the guidelines do a complete examination?
Are they measurable? Are the three indicators measurable and easy to measure in terms of completely done or not?
Are they attainable? Can at least 90% of the people committed to follow the guidelines easily do a complete examination?
Can they contribute to achievement of the end-goal and present target of BSE and PEB in the early detection of breast cancer, that is, 90% of the people who practice BSE and PEB based on recommended guidelines shall have a palpable breast cancer detected and recognized at a size NOT more 2 finger breaths (about 2-3 cm).
If the answers to the 4 assessment questions are all YES, then recommendation is to adopt for the moment and validate with the understanding that these indicators may change over time.
QI. What constitutes an accurate breast self-examination? An accurate physical examination of the breast?
“Accurate” shall be operationally defined as “accurate” using the following indicators:
Accurate in the detection and recognition of something unusual on BSE and PEB.
The detection and recognition of something unusual on BSE done by a non-physician must at least be concurred by a physician, preferably, a breast specialist to be considered “accurate.” For finding of something unusual on PEB done by a non-breast specialist (trained non-physicians, non-breast specialist physicians), this must be concurred by a breast specialist to be considered “accurate.”
Accurate in the detection and recognition of a dominant breast mass on BSE and PEB.
A dominant mass is a finding of an unusual density on palpation of the breasts discerned from comparison with surrounding breast tissues of the same breast and with the corresponding area in the contralateral breast. The density is distinct from the surrounding tissue with a felt margin or border which may be discrete or poorly-defined and which connotes a three dimensional mass.
The detection and recognition of a dominant breast mass on BSE done by a non-physician must at least be concurred by a physician, preferably, a breast specialist to be considered “accurate.” For finding of a dominant breast mass on PEB done by a non-breast specialist (trained non-physicians, non-breast specialist physicians), this must be concurred by a breast specialist to be considered “accurate.”
“Accuracy” is operationally defined as concurrence by a physician breast specialist.
Assessment of the formulated indicators:
Are they simple? Will formulated indicators be easily understood by at least 90% of the people committed to follow the guidelines? With some explanation and training, will these people easily know what is and how to detect “something unusual” and “dominant mass”? Are the “accuracy” indicators simple to measure (concurrence by a breast specialist)?
Are they measurable? Are the “accuracy” indicators measurable and easy to measure (concurrence by a breast specialist)?
Are they attainable? Can at least 90% of the people committed to follow the guidelines easily do an accurate BSE and PEB?
Can they contribute to achievement of the end-goal and present target of BSE and PEB in the early detection of breast cancer, that is, 90% of the people who practice BSE and PEB based on recommended guidelines shall have a palpable breast cancer detected and recognized at a size NOT more 2 finger breaths (about 2-3 cm).
If the answers to the 4 assessment questions are all YES, then recommendation is to adopt for the moment and validate with the understanding that these indicators may change over time.
QI. What constitutes a quality breast self-examination? A quality physical examination of the breast?
“Quality” shall be operationally defined as those characteristics or indicators that contribute to meeting the expectations and satisfaction of the patient-clients concerned with breast cancer.
Assessment of the formulated indicators:
Are they simple? Will formulated indicators be easily understood by at least 90% of the people committed to follow the guidelines?
Are they measurable? Is it easy to evaluate “privacy respected,” “gentle palpation,” “complete examination,” and “accurate examination”?
Are they attainable? Can at least 90% of the people committed to follow the guidelines easily accomplish the formulated indicators of quality of BSE and PEB?
Can they contribute to achievement of the end-goal and present target of BSE and PEB in the early detection of breast cancer, that is, 90% of the people who practice BSE and PEB based on recommended guidelines shall have a palpable breast cancer detected and recognized at a size NOT more 2 finger breaths (about 2-3 cm).
If the answers to the 4 assessment questions are all YES, then recommendation is to adopt for the moment and validate with the understanding that these indicators may change over time.