Doing a BSE with confidence starts on the same day as being informed by your physician that the exam is normal. Start the exam process by reminding yourself to relax and that your breasts are normal. Your goal is to create a mental image of the normal. Visualize, don’t analyze. Click here to watch a video about the key points on doing a breast self exam.
Start the exam by focusing on one area of the breast. Use the pads of the middle three fingertips to make a one inch circle. Vary the pressure to maximize the “normal texture.” Concentrate and try to visualize the pattern much like how a blind person would do to learn braille. Experiment and find the most comfortable approach for you. The basic concept is to use on-inch overlapping circles. Cover the entire breast from the collar bone to bra line and from the mid-chest to armpit. Go over breast completely, but do not expect to be confident after one night. It typically takes several nights to gain the necessary level of confidence. Try to spend 15-30 min at first or do it until you lose focus. Once you are confident, do it once per month. Menopausal women can do it on any day, but I suggest that my patient start on the first day of every month.
Stop looking for lumps. It only makes you nervous. Once you know the normal and do the exam on a regular basis, you will immediately recognize any important change. If you find a change, report it to your doctor. Remember that most change will not be cancer, but it is your doctor’s responsibility to determine the nature of the change (cancer or not cancer)? The doctor starts with a careful exam of both breasts with a final focus on the area of the patient’s concern. If the exam is normal, an ultra-sound is performed on the area of concern. If the mammogram is not up to date, a diagnostic mammogram is ordered with special views of the area of concern. If it is concluded that the initial evaluation is unremarkable, the patient should return for a follow-up visit in 1-3 months (based on the patients and physicians level of concern).
Menstruating women should schedule their follow-up visit 5-10 days after the onset of their period. If symptoms are gone on follow-up visit, the patient can return to routine yearly follow-up. If the woman remains symptomatic, a diagnostic mammogram should be done if not already performed. Even if the diagnostic mammogram is negative, tissue sampling by either needle or open biopsy must be considered. Also, consideration should be given for having a breast MRI. If a woman remains concerned because of a persistent change and her doctor does not follow these basic steps, the woman should consider getting a second opinion.