Women should be encouraged to perform breast self-examination monthly starting at age 20 years. It is important for a woman to learn what is normal and about the changes in her breasts that occur with her menstrual cycle. Familiarity with breast tissue makes it easier for the woman to notice any changes in the breast from month to month.
Advise the woman that the best time to perform breast self-examination is 2 to 3 days to a week after the end of her menstrual period. At this time the breasts are less tender or swollen. Women taking oral contraceptives are encouraged to do their breast self-examination each month on the day they begin their new package of pills. A woman past menopause should be advised to pick a particular day of the month and then perform the examination monthly.
Advise the patient that if she discovers anything unusual, such as a lump, discharge from the nipple, or dimpling of the skin, she should seek medical attention. Inform her that 8 of 10 breast lumps are not cancer.
The techniques of breast self-examination are included here for the purpose of patient education:
1. Stand with your arms at your sides in front of a mirror. Inspect both breasts for anything unusual, such as dimpling, puckering, discharge from the nipples, or scaling of the skin.
2. Raise your arms and clasp your hands behind your head. Press your hands forward. Look in the mirror for any changes in the breast tissue.
3. Put your hands down and place them on your hips. Bend slightly toward the mirror as you pull your shoulders and elbows forward.
4. Raise your right arm;using the pads of your left fingers, press into your right breast firmly, carefully, and thoroughly. Start at the upper outer edge and move in small circles, moving the circles slowly around the breast. Pay special attention to the breast tissue between the breast and the underarm. Use a massaging motion.
5. Gently squeeze your nipple and look for any discharge.
6. Repeat steps 4 and 5 while lying down with a small pillow under your right shoulder. Place your right arm over your head.
There are several errors that patients make with regard to breast self-examination. The first is failure to perform self-examination. The second is failure to examine the breasts both in the sitting (or standing) position and when lying down. The third is failure to use a pillow under the side that is being examined. The fourth is failure to raise the arm (on the side being examined) above the head and relax it.
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