List of Breast Wellness Problems
Breast disorders / diseases affecting the state of breast wellness
All known breast disorders / diseases that affect the physical, psychosocial, and spiritual well-being and/or socioeconomic productivity of the persons who have them and of a significant number of persons in the community.
Both malignant and non-malignant breast disorders / diseases
Symptoms on the breast but without a breast disorder / disease and affecting the state of breast wellness
Examples:
Mastalgia without a breast disorder / disease
Nipple discharge without a breast disorder / disease
Unequal size of the breast without a breast disorder / disease
Fear and anxiety even in the absence of a breast disorder / disease / symptom and affecting the state of breast wellness
Examples:
Fear and anxiety for breast cancer just because a relative or a friend got one
Fear and anxiety for breast cancer because of scary media campaign
Fear and anxiety for breast cancer because of an alarming reading on imaging studies
Magnitude of Breast Wellness Problems
Strategies on Reducing the Breast Wellness Programs
How useful are breast self-examination and physical examination of the breast, singly or in combination, in reducing the magnitude of the breast wellness problems in the Philippines?
BSE and PEB can be used in reducing the magnitude of the three groups of breast wellness problems listed in the table. BSE and PEB are initially educational tools before being technical tools in detecting and recognizing breast wellness problems. As such, they, in combination (BSE and PEB), can be used in the education for early recognition and consult in Group 1 of breast wellness problems (breast disorders / diseases) to reduce the magnitude of the complications / morbidities / mortalities). People doing quality, complete, and accurate BSE and PEB and accomplishing them at the recommended frequency will have greater chances for earlier detection and recognition of breast cancer and other breast disorders and diseases than those who are not doing them properly and accomplishing them longer than the recommend frequency. People with earlier detection and recognition and with early treatment will have lesser chances of complications / morbidities / mortalities associated with the disease and with the treatment than those who have more advanced diseases and being treated at this stage.
In Group 2 of breast wellness problems, BSE and PEB, in combination, as educational tools, can be used as a strategy to reduce the magnitude of symptoms on the breast but without a breast disorder / disease. With proper understanding of the breast conditions and allayance of fear that come with BSE and PEB, there will be reduction of complaints and symptoms on at least the following:
Mastalgia without a breast disorder / disease
Nipple discharge without a breast disorder / disease
Unequal size of the breast without a breast disorder / disease
In Group 3 of breast wellness problems, BSE and PEB, in combination, as educational tools, can be used as a strategy to reduce the magnitude of fear and anxiety even in the absence of a breast disorder / disease / symptom. With proper understanding of the breast conditions and allayance of fear and anxiety that come with BSE and PEB, there will be reduction of at least the following:
Fear and anxiety for breast cancer just because a relative or a friend got one
Fear and anxiety for breast cancer because of scary media campaign
Fear and anxiety for breast cancer because of an alarming reading on imaging studies
Evidences on the Usefulness of breast self-examination and physical examination of the breast
Unfortunately, search of the medical literature showed NO research studies that advocated the use of breast self-examination and physical examination of the breast.
There are two large population-based studies (388,535 women) from Russia and Shanghai that compared breast self-examination with no intervention. There was no statistically significant difference in breast cancer mortality between the groups.
There is one large population-based trial of clinical breast examination combined with breast self-examination but this trial was discontinued because of poor compliance with follow up and no conclusions can be drawn from the study.
http://www2.cochrane.org/reviews/en/ab003373.html
Kösters JP, Gøtzsche PC. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003373. DOI: 10.1002/14651858.CD003373
Despite the medical literature having NO research studies that advocated the use of breast self-examination and physical examination of the breast, many health institutions globally still advocate the use of breast self-examination and physical examination of the breast as part of the strategies in the early detection and recognition of breast cancers and other breast concerns.
No one can say that breast self-examination and physical examination of the breast are useless.
As explained above, BSE and PEB can be used in reducing the magnitude of the three groups of breast wellness problems seen in the Philippines, namely, to reduce the magnitude of the complications / morbidities / mortalities with early detection and recognition; to reduce the magnitude of symptoms on the breast but without a breast disorder / disease; and to reduce the magnitude of fear and anxiety even in the absence of a breast disorder / disease / symptom. .
Below are more arguments in favor of doing BSE and PEB.
At present, majority of the discovery of a palpable breast mass originate from the person who has the breast mass through a breast self-examination. Every person is in the better position than anybody else, even the breast specialists, to discover a palpable breast mass as he / she can inspect and palpate her / his breast every day, anytime, and repetitively (this is on the assumption that everybody is taught how to do quality BSE and which should be done). Thus, BSE should be advocated and promoted with development of a habit and a competency of doing a quality BSE.
A physical examination of the breast, done both for screening and diagnostic purpose, can complement and reinforce the usefulness of BSE in promoting early detection and recognition of breast disorders and diseases, particularly breast cancer. With patient education, correction of misconceptions, and allayance of unfounded fear and anxiety that go with the PEB, the latter can reduce the magnitude of symptoms on the breast but without a breast disorder / disease; and to reduce the magnitude of fear and anxiety even in the absence of a breast disorder / disease / symptom. PEB is not only for restoring and maintaining physical wellness but also for restoring and maintaining mental wellness.
Another usefulness of PEB, especially done by a breast specialist, is an advice on the rational use of diagnostic tests, whether indicated or not, and if indicated, what test or tests. Without PEB, there will be NO gatekeeper in the use of diagnostic tests.
The conventional breast cancer staging (TNM) and the accompanying data on survival for each stage is another argument in support of BSE and PEB. The higher the stage, the poorer the prognosis or survival rate. The smaller the breast tumor size (T) on detection, the lower the stage. The T in stage 1 is 2 cm and smaller. The T in stage 2 is more than 2 cm to 5 cm. The T in stage 3 is more than 5 cm. BSE and PEB can detect a palpable breast cancer tumor as small as one cm. Thus, people doing quality, complete, and accurate BSE and PEB and accomplishing them at the recommended frequency will have greater chances for detecting a palpable breast cancer mass at a smaller size than those who are not doing them properly and accomplishing them longer than the recommend frequency.