Starting at approximately age 21 women should see their health care provider on a yearly basis, and during this examination a methodical examination of the breast and armpit should be performed. If this examination is normal as it will be in the vast majority of cares, it serves as the starting point for women to gain confidence in doing BSE. Once a woman becomes aware of her normal pattern of “lumpiness”, she can spend the next few days repeating herself-examination until she has a clear mental image of her normal baseline examination.
Of note, the vast majority of breast lumps are found by women themselves, and less than 5% are found by a member of the medical team. Unfortunately, most lumps found by women are not found during a routine breast self-examination (they are found incidentally, perhaps while bathing or dressing), so the clinician’s screening examination can still be lifesaving for those women who do not do BSE with confidence.
When a physician is presented with a patient who has found a new area of concern on BSE, specific steps are required to make an accurate diagnosis. The physician must perform a careful physical examination. In most cases a diagnostic mammogram and ultrasound exam should be performed. If the clinical exam is indeterminate, tissue samplings should be performed using non-invasive techniques. If tissues sampling is judged not to be required, then careful follow-up is mandatory. If the area of concern is still present at a 1-2 month follow-up exam, tissue sampling should be strongly considered.