1. Breast Self – Examination (BSE)

2. BSE Breast self-examination (BSE) is a screening method used in an attempt to detect early breast cancer. The method involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling.

3. BSE A breast self-examination involves checking your breasts for lumps or changes while standing and lying in different positions and while looking at your breasts in a mirror to note any changes in their appearance. Once you know what your breasts normally look and feels like, any new lump or change in appearance should be evaluated by a doctor.

4. Why It Is Done A breast self-examination is done to detect breast problems, such as a lump or change in appearance, that may indicate breast cancer or other breast conditions that may require medical attention.

5. How To Prepare No special preparation is needed before having this test. Time Required: 15 minutes a month

6. What You Need: A mirror which lets you see both breasts A pillow for your head and shoulders Privacy

7. How It Is Done It takes practice to perform a thorough breast self-examination. Ask your doctor for tips that can help you perform a breast self-examination correctly.

8. How It Is Done The best time to examine your breasts is usually one week after your menstrual period begins, when your breast tissue is least likely to be swollen or tender. If your menstrual cycle is irregular, or if you have stopped menstruating due to menopause or the removal of your uterus (hysterectomy), do your examination on a day of the month that's easy to remember.

9. How It Is Done Women who are pregnant or breast-feeding can continue to examine their breasts every month. Breast-feeding mothers can examine their breasts after a feeding or after using a breast pump so that the breasts have as little milk as possible, making the examination easier and more comfortable.

10. How It Is Done Use the pads of the three middle fingers of your left hand-not your fingertips-to check your right breast. Move your fingers slowly in small coin- sized circles.

11. Changes to look for: Check with your health care provider if you find any change in your breast(s) that causes you concern. Changes in your breasts may include: Development of a lump A discharge other than breast milk Swelling of the breast Skin irritation or dimpling Nipple abnormalities (such as pain, redness, scaliness, or turning inward)

12. How to do BSE: Step 1. Make a regular date for your BSE If you are pre-menopausal: Set a regular time to examine your breasts a few days after your period ends, when hormone levels are relatively stable and breasts are less tender. If you are already menopausal (have not had a period for a year or more): Pick a particular day of the month to do the exam, and then repeat your BSE on that day each month.

13. How to do BSE: Step 2. In the privacy of your bathroom or bedroom, strip to the waist and stand before a mirror. You will need to see both breasts at the same time. Stand in front of a mirror that is large enough for you to see your breasts clearly. Check each breast for anything unusual. Check the skin for puckering, dimpling, or scaliness. Look for a discharge from the nipples.

14. How to do BSE:

15. 3.Visual Exam - Arms Over Your Head Still standing in front of the mirror, raise your arms over your head and see if your breasts move in the same way, and note any differences. Look at size, shape, and drape, checking for symmetry. Pay attention to your nipples and areolas, to see if you have any dimples, bumps, or retraction (indentation). Look up toward your armpits and note if there is any swelling where your lymph nodes are (lower armpit area).

16. Watching closely in the mirror, clasp your hands behind your head and press your hands forward.

17. 4. Visual Exam - Hands on Hips Stand with your hands on your hips and check the appearance of your breasts. Look at size, shape, and contour. Note changes, if any, in the skin color or texture. Look at the nipples and areolas, to see how healthy they look.

18. 5.Next, press your hands firmly on your hips and bend slightly toward the mirror as you pull your shoulders and elbows forward. Check for any change in the shape or contour of your breasts. As you do these steps, you should feel your chest muscles tighten.

19. 6. Manual Exam - Stand and Stroke Raise your left arm overhead, and use your right-hand fingers to apply gentle pressure to the left breast. Stroke from the top to the bottom of the breast, moving across from the inside of the breast all the way into your armpit area.

20. You can also use a circular motion, being sure to cover the entire breast area. Take note of any changes in texture, color, or size. Switch sides and repeat. This is best done in the shower, as wet skin will have the least resistance to the friction of your fingers.

21. 7. Manual Exam - Check Your Nipples Still facing the mirror, lower both arms. With the index and middle fingers of your right hand, gently squeeze the left nipple and pull forward. Does the nipple spring back into place? Does it pull back into the breast? Note whether or not any fluid leaks out. Reverse your hands and check the right nipple in the same way.

22. Gently squeeze each nipple and look for a discharge.

23. 8. Manual Exam - Recline and Stroke This is best done in your bedroom, where you can lie down. The breasts are best examined while lying down because it spreads the breast tissue evenly over the chest. Lie flat on your back, with one arm over your head and a pillow or folded towel under the shoulder or you can lie with both your head and shoulders on the pillow. This position flattens the breast and makes it easier to check.

24. Put your left hand behind your head. Use your right hand to stroke the breast and underarm, as you did in step 6. Take note of any changes in texture, color, or size. Switch sides and repeat.

25. Use the pads of the fingers of your other hand to check the breast and the surrounding area firmly, carefully, and thoroughly. Some women like to use lotion or powder to help their fingers glide easily over the skin.

26. Feel for any unusual lump or mass under the skin. Feel the tissue by pressing your fingers in small, overlapping areas about the size of a dime. To be sure you cover the whole breast, take your time and follow a definite pattern: lines, circles, or wedges.

27. Some research suggests that many women do BSE more thoroughly when they use a pattern of up-and-down lines or strips. Other women feel more comfortable with other patterns. The important thing is to cover the whole breast and pay special attention to the area between the breast and the underarm, including the underarm itself.

28. Check the area above the breast, up to the collarbone, and all the way over to your shoulder.

29. Consider using one of these patterns: Lines. Start in the underarm area and move your fingers downward little by little until they are below the breast. Then move your fingers slightly toward the middle and slowly move back up. Go up and down until you cover the whole area.

30. Consider using one of these patterns: Circles. Beginning at the outer edge of your breast, move your fingers slowly around the whole breast in a circle. Move around the breast in smaller and smaller circles, gradually working toward the nipple. Don't forget to check the underarm and upper chest areas, too.

31. Consider using one of these patterns: Wedges. Starting at the outer edge of the breast, move your fingers toward the nipple and back to the edge. Check your whole breast, covering one small, wedge-shaped section at a time. Be sure to check the underarm area and the upper chest.

32. The American Cancer Society recommends using three different levels of pressure to examine your breasts: Light pressure—to examine the tissue closest to the skin Medium pressure—to feel a little deeper Firm pressure—to feel deeper tissue closer to the chest wall

33. Some women repeat step 6 in the shower. Your fingers will glide easily over soapy skin, so you can focus on feeling for changes underneath.

34. What if you find a lump? One of the most frightening moments for a woman is seeing or feeling something different or unusual while performing breast self- examination. One of the most important reasons to do regular breast self-examination is that you know what is normal for your breasts. If you find a lump, it is important not to panic.

35. If you discover lumpiness in one breast or feel something "different" in the tissue, or if you feel a definite lump, there may be valid reason for concern, and it is important to contact a health care provider. Sometimes, the lumpiness may be due to menstrual changes, but if you have nipple discharge or skin changes such as dimpling or puckering, your health care provider may want to see you right away.

36. It is natural to be frightened when discovering a lump, but do not let the prospect of cancer keep you from taking action. Remember that most breast lumps are benign (not cancer).

37. Tips For Doing Your BSE Mark your calendar to remind yourself to do your BSE regularly. This is a good way to prevent worry if find a normal cyclic change. Stay relaxed and breathe normally as you do your BSE. Becoming tense will produce some knots that you may mistake for something worrisome.

38. Tips For Doing Your BSE Report any changes or unusual pain to your doctor or nurse practitioner. Keep a log of changes, if that helps you remember. Remember to have an annual clinical exam and a mammogram.

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40. Thank you!