Although there is more than one way of skinning a cat, to lessen confusion particularly on the part of the public and to make them easier to adopt for a habit, standardization of the techniques along the direction of simplicity and being goal-oriented is recommended.
Breast Self-examination (BSE) can be done by lay and health professionals. Physical Examination of the Breast (PEB) can be done by lay and non-health professionals; non-breast specialist physicians; and physician-breast specialists. Although there will be differences in expectations on the completeness and accuracy among the different kinds of examiners, for alignment purposes, the proposed essential elements in the techniques of BSE and PEB should be the same as much as possible.
Breast Self-examination (BSE)
RecommendedTechniques
Objectives:
To look and feel for anything unusual that may be present on the breasts!
To look and feel for a dominant mass that may be present in the breasts!
Two –part examination procedures in BSE:
Visual inspection (look)
Manual palpation (feel)
Visual Inspection (LOOK)
Expose upper body.
In standing position, face a mirror to view entire chest and breasts.
With both arms down and then raised over the head, look for anything unusual on the breasts!
Look for changes in the contour of the breasts and armpits, such as bulge, skin dimpling, and flattening!
Look for unusual changes on the skin of the breasts, such as redness and lesions!
Manual Palpation (FEEL)
In standing position, with one arm raised over the head, using the flats of 2-3 fingers (2nd to 4th fingers) of the other hand, gently but firmly palpate the entire breast on the side where the arm is raised. Feel for anything unusual in the breast and feel for a possible presence of a dominant mass! Cover the entire area of the breast by either going one quadrant at a time until all four quadrants of the breast are palpated or moving in an up-and-down vertical strip pattern of palpation, starting from the inner side to outer side of the breast. Before palpating the armpit, gently squeeze the nipple for possible presence of discharge.
When palpating the armpit, put the arm down to have a lax fold. Place the palpating fingers initially at the uppermost portion of the armpit. Then, gently but firmly press against the chest wall in the armpit and slowly glide the fingers downward to feel for anything unusual and to feel for a possible presence of a dominant mass!
Repeat the same procedures for the other breast, nipple, and armpit.
If anything unusual or a dominant mass is detected, consult a breast specialist as soon as possible!
Physical Examination of the Breast (PEB)
Recommended Techniques
Objectives:
To look and feel for anything unusual that may be present on the breasts!
To look and feel for a dominant mass that may be present in the breasts!
Two –part examination procedures in BSE:
Visual inspection (look)
Manual palpation (feel)
Visual Inspection (LOOK)
Ask the person who is to undergo physical examination of the breast (examinee or patient) to expose upper body. Observe and respect privacy.
Ask the patient to lie down on the examination table.
With both arms down and then raised over the head, look for anything unusual on the breasts!
Look for changes in the contour of the breasts and armpits, such as bulge, skin dimpling, and flattening!
Look for unusual changes on the skin of the breasts, such as redness and lesions!
Manual Palpation (FEEL)
With the patient in a lying down position, with one arm raised over the head, using the flats of 2-3 fingers (2nd to 4th fingers), gently but firmly palpate the entire breast on the side where the arm is raised. The other hand of the examiner may be used to support the breast while the other hand is being used to palpate. Feel for anything unusual in the breast and feel for a possible presence of a dominant mass! Cover the entire area of the breast by either going one quadrant at a time until all four quadrants of the breast are palpated or moving in an up-and-down vertical strip pattern of palpation, starting from the inner side to outer side of the breast. Before palpating the armpit, gently squeeze the nipple for possible presence of discharge.
When palpating the armpit, put the arm down to have a lax fold. Place the palpating fingers initially at the uppermost portion of the armpit. Then, gently but firmly press against the chest wall in the armpit and slowly glide the fingers downward to feel for anything unusual and to feel for a possible presence of a dominant mass!
Repeat the same procedures for the other breast, nipple, and armpit.
If anything unusual or a dominant mass is detected by a non-physician examiner or non-breast specialist, consult a breast specialist as soon as possible!
If anything unusual or a dominant mass is detected by a physician-examiner or breast specialist, the characteristics of what was detected are determined and described, such as size, consistency, nature of the dominant mass, movability, etc. Other parts of the body can be inspected and palpated as deemed necessary.