1. BREAST SELF EXAMINATION
Dr.Malleswar Rao Kasina MD,DGO
Special Grade Civil Surgeon,
Dept. of ObGyn, ESI Hospital,
Hyderabad, AP, India

2. Breast cancer screening
Early detection is an important factor in the success of breast cancer treatment. The earlier breast cancer is found, the more easily and successfully it can be treated.
The three methods commonly used for early detection are:
Breast self-exam (BSE).
Clinical breast exam (CBE).
Mammogram.

3. Breast cancer screening
Magnetic resonance imaging (MRI) of the breast may be most useful for very high-risk women, such as those who test positive for the BRCA1 or BRCA2 gene, or have two or more close family members who have had breast cancer before age 50.5 MRI may also be used to evaluate the opposite breast in women diagnosed with breast cancer.

4. Breast cancer screening (Women at high risk of Breast Cancer)
Age
Early Menarche
Late Menopause
Nullipara
First pregnancy at advanced age
Absence of Breast Feeding
Long h/o Infertility
Diabetes
Hypertension
Family h/o Cancer Ovary, Breast, Colon (Ist degree)
H/o Cancer in Opposite Breast
Obesity
Genetic

5. Breast cancer screening
The type and frequency of breast cancer screening that is best for you changes as you age.
Ages 18 to 39: You should have a clinical breast exam every 3 years. If you have a high risk for developing breast cancer, talk to your health professional about when to begin having annual mammograms.

6. Breast cancer screening
Ages 40 to 69: Annual clinical breast exams are recommended by all experts for women in this age group. Annual mammography is recommended for women older than age 50.
Age 70 and over: If you are 70 or older, talk to your health professional about mammography as a regular part of your health care plan.

7. How Do I Examine My Breasts?
There are two parts to a BSE:
how your breasts look
how they feel

8. How Do I Examine My Breasts?
stand or sit in front of a mirror with your arms relaxed at your sides. Look at your breasts carefully. Do you see anything unusual, like a change in the way your nipples look? Any dimples or changes in the skin?

9. How Do I Examine My Breasts?

10. How Do I Examine My Breasts
You can also examine your breasts as you lie on your back on your bed. Use the same method described above, raising one arm and using the other hand to check your breast in a spiral motion.

11. BREAST SELF EXAMINATION
Monthly breast self-exams are an option for all women beginning by age 20. Women who regularly examine their breasts become more aware of how their breasts normally feel.
They are more likely to notice changes -- including masses or lumps -- that could be early signs of cancer.

12. BREAST SELF EXAMINATION
It's best to check about a week after your period, when breasts are not swollen or tender.
If you no longer have a period, examine yourself on the same day every month.
If you see or feel a change in your breasts, see your doctor immediately. But remember, most of the time breast changes are not cancer.

13. BREAST SELF EXAMINATION
Using a mirror, inspect your breasts with your arms at your sides, with your hands on your hips, and with your arms raised while flexing your chest muscles.

14. BREAST SELF EXAMINATION
Look for any changes in contour, swelling, dimpling of skin, or appearance of the nipple. It is normal if your right and left breasts do not match exactly.

15. BREAST SELF EXAMINATION
Using the pads of your fingers, press firmly on your breast, checking the entire breast and armpit area. Move around your breast in a circular, up-and-down, or wedge pattern. Remember to use the same method every month. Check both breasts.

16. BREAST SELF EXAMINATION
There are three patterns you can use to examine your breast: the circular, the up-and-down, and the wedge patterns. Use the pattern that is easiest for you, and use the same pattern every month.

17. BREAST SELF EXAMINATION
Gently squeeze the nipple of each breast and report any discharge to your doctor immediately.

18. BREAST SELF EXAMINATION
Examine both breasts lying down. To examine the right breast, place a pillow under your right shoulder and place your right hand behind your head. Using the pads of your fingers, press firmly, checking the entire breast and armpit area. Use the same pattern you used while standing. Repeat for your left breast.

19. BREAST SELF EXAMINATION
The most effective way to fight breast cancer is to detect it early. Although the most effective tools to detect breast cancer are mammography and clinical breast exam by your health professional, the breast self-exam may also be an effective tool to find cancer early. In fact, women who perform regular breast self-exam find 90% of all breast masses.

20. BREAST SELF EXAMINATION (FAQ)
What is a breast self-exam and why should I do it?
The breast self-exam is a way that you can check your breasts for changes (such lumps or thickenings) that may signal breast cancer. When breast cancer is detected in its early stages, your chances for surviving the disease are greatly improved. While 80% of all breast lumps are not cancerous, you can help catch potentially serious changes in the breast early by regularly performing a self-exam.

21. BREAST SELF EXAMINATION (FAQ)
When should I perform a breast self-exam?
It is good to start performing breast self exams in your 20's. You should examine your breasts once a month, three to five days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month, such as the first day of the month or a day easy for you to remember, such as your birth date. With each exam, you will become familiar with the contours and feel of your breasts, and will be more alert to changes.

22. BREAST SELF EXAMINATION (FAQ)
How do I perform a breast self-exam?
To perform a breast self-exam, follow the steps described below.

23. BREAST SELF EXAMINATION (FAQ)
In the mirror: -
1) Stand undressed from the waist up in front of a large mirror in a well-lit room. Look at your breasts. Don't be alarmed if they do not look equal in size or shape. Most women's breasts aren't. With your arms relaxed by your sides, look for any changes size, shape or position, or any changes to the skin of the breasts.
Look for any skin puckering, dimpling, sores or discoloration. Inspect your nipples and look for any sores, peeling or change in the direction of the nipples.

24. BREAST SELF EXAMINATION (FAQ)
2) Next, place your hands on your hips and press down firmly to tighten the chest muscles beneath your breasts. Turn from side to side so you can inspect the outer part of your breasts.
3) Then bend forward toward the mirror. Roll your shoulders and elbows forward to tighten your chest muscles. Your breasts will fall forward. Look for any changes in the shape or contour of your breasts.

25. BREAST SELF EXAMINATION (FAQ)
4) Now, clasp your hands behind your head and press your hands forward. Again, turn from side to side to inspect your breasts' outer portions. Remember to inspect the border underneath your breasts. You may need to lift your breasts with your hand to see this area.
5) Check your nipples for discharge (fluid). Place your thumb and forefinger on the tissue surrounding the nipple and pull outward toward the end of the nipple. Look for any discharge. Repeat on your other breast

26. BREAST SELF EXAMINATION (FAQ)
In the shower: -
6) Now, it's time to feel for changes in the breast. It is helpful to have your hands slippery with soap and water. Check for any lumps or thickening in your underarm area. Place your left hand on your hip and reach with your right hand to feel in the left armpit. Repeat on the other side.

27. BREAST SELF EXAMINATION (FAQ)
7) Check both sides for lumps or thickenings above and below your collarbone.
8) With hands soapy, raise one arm behind your head to spread out the breast tissue. Use the flat part of your fingers from the other hand to press gently into the breast. Follow an up-and-down pattern along the breast, moving from bra line to collarbone. Continue the pattern until you have covered the entire breast. Repeat on the other side.

28. BREAST SELF EXAMINATION (FAQ)
Lying down: -
9) Next, lie down and place a small pillow or folded towel under your right shoulder. Put your right hand behind your head. Place your left hand on the upper portion of your right breast with fingers together and flat. Body lotion may help to make this part of the exam easier.

29. BREAST SELF EXAMINATION (FAQ)
10) Think of your breast as a face on a clock. Start at 12 o'clock and move toward 1 o'clock in small circular motions. Continue around the entire circle until you reach 12 o'clock again. Keep your fingers flat and in constant contact with your breast. When the circle is complete, move in one inch toward the nipple and complete another circle around the clock. Continue in this pattern until you've felt the entire breast. Make sure to feel the upper outer areas that extend into your armpit.

30. BREAST SELF EXAMINATION (FAQ)
11) Place your fingers flat and directly on top of your nipple. Feel beneath the nipple for any changes. Gently press your nipple inward. It should move easily.
Repeat steps 9, 10 and 11 on your other breast.

31. BREAST SELF EXAMINATION (FAQ)
Interestingly, cancerous tumors are more likely to be found in certain parts of the breast over others. If you divide the breast into 4 sections, the approximate percentage of breast cancers found in each area are (in clockwise pattern):
41% upper, outer quadrant
14% upper, inner quadrant
5% lower, inner quadrant
6% lower, outer quadrant
34% in the area behind the nipple

32. BREAST SELF EXAMINATION (FAQ)
Almost half occur in the upper outer quadrant of the breast, towards the armpit. Some physicians refer to this region as the "tail" of the breast and encourage women to examine it closely.

33. BREAST SELF EXAMINATION (FAQ)
What should I do if I find a lump?
See healthcare provider if you discover any new breast changes, changes that persist after your menstrual cycle, or other changes that you are concerned about. Conditions that should be checked by a doctor include:

34. BREAST SELF EXAMINATION(FAQ)
An area that is distinctly different from any other area on either breast
Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle
A change in the size, shape or contour of the breast
A mass or lump, which may feel as small as a pea
A marble-like area under the skin
A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly or inflamed)
Bloody or clear fluid discharge from the nipples
Redness of the skin on the breast or nipple

35. BREAST SELF EXAMINATION

36. BREAST SELF EXAMINATION

37. BREAST SELF EXAMINATION

38. BREAST SELF EXAMINATION

39. BREAST SELF EXAMINATION

40. BREAST SELF EXAMINATION
To perform a breast self-exam, use a circling, massaging motion and follow a clock pattern or a wedge pattern. Alternatively, you can use a sweeping motion to examine breast tissue — sweeping your fingers from the outer part of your breast in toward your nipple.

41. Breast self-exam using a clock pattern
Visualize your breast as the face of a clock.
Place your left hand behind your head and examine your left breast with your right hand.
Place your right hand at 12 o'clock — at the very top of your breast.
Press the pads of your three middle fingers firmly on your breast in a slight circling, massaging motion.

42. Breast self-exam using a clock pattern
Move your hand down to 1 o'clock, then 2 o'clock, continuing until you return to 12 o'clock.
Continue in the same pattern, moving your hand in smaller circles toward your nipple.
Check the tissue under the nipple and look for discharge.
Check the tissue under your armpit and surrounding your breast.
Place your right hand behind your head and repeat the examination on your right breast using your left hand.

43. Breast self-exam using a wedge pattern
Visualize your breast as a circle divided into wedges, like pieces of a pie.
Place your left hand behind your head and examine your left breast with your right hand.
Press the pads of your three middle fingers firmly on your breast in a slight circling, massaging motion.
Start at the top of your breast about a half-inch below your collarbone and slide your fingers in toward your nipple as you massage.

44. Breast self-exam using a wedge pattern
Examine the breast tissue in the entire wedge — or piece of pie.
Move your fingers clockwise to the next wedge in the circle.
Continue examining your breast in this manner until you've completely examined your breast and underarm.
Place your right hand behind your head and repeat the examination on your right breast using your left hand.

45. Breast self-exam using a sweeping technique
Place your left hand behind your head and examine your left breast with your right hand.
Instead of a circling, massaging motion, sweep your three middle fingers from your collarbone down to your nipple.
Work clockwise around your breast.
Sweep your fingers from the outside of your breast in toward your nipple.

46. Breast self-exam using a sweeping technique
To feel deeper breast tissue, repeat the process using a walking motion with your fingers.
Continue examining your breast in this manner until you've completely examined your breast and underarm.
Place your right hand behind your head and repeat the examination on your right breast using your left hand.

47. When should you start breast self-exams?
The American Cancer Society recommends that doctors inform women about the benefits and limitations of breast self-exams when they reach age 20. That's the age you should begin breast self-exams. Whether or not you perform breast self-exams, you should have a clinical breast exam by a health professional every three years until you're 40. After age 40, schedule a clinical breast exam and a mammogram every year.

48. What's the best time for breast self-exams?
The best time to perform a breast self-exam is about a week after the start of your period. That's when your breasts are least likely to be tender or swollen. Your breast tissue undergoes changes each month during your menstrual cycle. Changes in hormone levels associated with menstruation cause your breasts to swell. Once your period starts, the swelling subsides and your breasts return to normal.
During pregnancy and nursing, your breasts may feel more lumpy than usual. If you have any questions about how your breasts look or feel, don't hesitate to ask your doctor about them.

49. Pros and cons of breast self-exams
One benefit of breast self-exams is the potential to identify and treat a cancerous breast lump while it's still small and in an early stage of development.
On the flip side, however, you might need a biopsy to evaluate an area of concern. If the biopsy results are noncancerous (benign), you might feel that you have undergone an invasive procedure unnecessarily.
Breast self-exams may also be challenging if you have normally lumpy (fibrocystic) breasts.

50. Pros and cons of breast self-exams
Breast self-exams alone don't reduce the number of deaths from breast cancer. Breast self-exams can miss tumors, as can other methods of screening. That's why it's important to rely on more than one method to screen for breast cancer.
A combined approach to breast cancer screening - including breast self-exams, clinical breast exams, mammography and magnetic resonance imaging (MRI) for certain high risk women - increases your chances of finding breast cancer at an early, treatable stage.

51. When To Call a Doctor
The most common symptom of breast cancer is a painless lump. But, early breast cancer is often found on a mammogram before a lump can be felt.
Any breast lump in an adult male is considered abnormal and needs to be evaluated by a doctor.

52. When To Call a Doctor
Other breast problems that need to be evaluated by a doctor include:
A thickening in the breast or armpit.
A change in the size or shape of the breast.
Changes in the skin of the breast, such as a dimple or skin that looks like an orange peel.
A change in the nipple, such as scaling of the skin, a nipple that turns in, or discharge or bleeding.
A change in the color or feel of the skin around the nipple.

53. References
National Breast and Cervical Cancer Early Detection Program Publications Available Online
Scientific Articles about Breast Cancer
Scientific Articles about Cervical Cancer

54. References
4.Guidance Documents
5.Breast Cancer Continuing Medical Education
6. Follow Up of Abnormal Clinical and Imaging Findings of the Breast: Five Self-Study Modules for Primary Care Clinicians

55. References
7. Breast and Cervical cancer screening guidelines

56. Thank you !!