7 P's of a Good BSE
1. Positions
Standing:
- First, stand in front of a mirror with your arms relaxed at your side.
- Then place your hands on your hips.
- Raise arms above your head.
- Bend slightly forward, allowing your arms to hang freely toward the floor.
In each position, look for changes in contour and shape of the breast, color and texture of the skin and nipple, and evidence of discharge from the nipples.
Palpation: Side-lying and flat:
- Use your left hand to palpate the right breast, while holding your right arm at a right angle to the rib cage, with the elbow bent.
- Repeat the procedure on the other side.
- The side-lying position allows a woman, especially one with large breasts, to most effectively examine the outer half of the breast. Do this by lying on the opposite side of the breast to be examined. Rotate the shoulder (on the same side as the breast to be examined) back to the flat surface.
- A woman with small breasts may only need the flat position. Lie flat on your back with a pillow or folded towel under the shoulder of the breast to be examined.
2. Perimeter
Visualize the perimeter of the breast as an imaginary line which extends down from the middle of the armpit to just beneath the breast. The imaginary line continues across along the underside of the breast to the middle of the breast bone, then moves up to and along the collar bone and back to the middle of the armpit. Most breast cancers occur in the upper outer section of this area (towards the shoulder and armpit).
3. Palpation
With Pads of the Fingers: Use the pads of three or four fingers to examine every inch of your breast tissue. Move your fingers in circles about the size of a dime. Do not lift your fingers from your breast between palpations. You can use powder or lotion to help your fingers glide from one spot to the next.
4. Pressure
Use varying levels of pressure for each palpation, from light to deep, to examine the full thickness of your breast tissue. Using pressure will not injure the breast.
5. Pattern of Search
Use one of the following search patterns to examine all of your breast tissue. Palpate carefully beneath the nipple. Any incision should also be carefully examined from end to end. Women who have had any breast surgery should still examine the entire area of the incision:
- Vertical Strip: Start in the armpit, proceed downward to the lower boundary. Move a finger's width toward the middle and continue palpating upward until you reach the collarbone. Repeat this until you have covered all breast tissue. Make at least six strips (passes with your fingers) before the nipple and four strips after the nipple. You may need between 10 and 16 strips.
- Wedge: Imagine your breast divided like the spokes of a wheel. Examine each separate segment, moving from the outside boundary toward the nipple. Slide fingers back to the boundary, move over a finger's width and repeat this procedure until you have covered all breast tissue. You may need between 10 and 16 segments.
- Circle: Imagine your breast as the face of a clock. Start at 12 o'clock and palpate along the boundary of each circle until you return to your starting point. Then move down a finger's width and continue palpating in ever smaller circles until you reach the nipple. Depending on the size of your breast, you may need eight to 10 circles.
6. Practice With Feedback
It is important that you perform a BSE while your instructor watches to be sure you are doing it correctly. Practice your skills under supervision until you feel comfortable and confident.
7. Plan of Action
Every woman should have a personal breast health plan of action:
- Discuss the American Cancer Society breast cancer detection guidelines with your health care professional.
- Schedule your clinical breast examination and mammogram as appropriate.
- Perform a BSE monthly. Ask your health professional for feedback on your BSE skills.
- Report any changes in your breast to your health care professional.
E-mail FGH OnCall or call us at 1-800-844-4445 for more information about BSE.
