ROJoson PEP Talk: Breast Self-Exam: To Do or Not To Do

ROJoson PEP Talk: Breast Self-Exam: To Do or Not To Do

1. Empowerment objective - for laypeople to have an understanding of the issues involved in BREAST SELF-EXAMINATION. December 11, 2021 1400H - 1500H Via Zoom Health Issue Breast Self-Examination: TO DO or NOT TO DO

2. Empowerment objective - for laypeople to have an understanding of the issues involved in BREAST SELF-EXAMINATION. Health Issue Breast Self-Examination: TO DO or NOT TO DO

3. Empowerment objective - for laypeople to have an understanding of the issues involved in BREAST SELF-EXAMINATION. ROJoson PEP Talk I have a Patient Empowerment Program in which I like to empower the lay people or patients to take control in the management of their health. Health Issue Breast Self-Examination: TO DO or NOT TO DO

4. There are 3 courses in the PEP Talk. I completed the Core Course on October 9, 2021.

5. From October 23, 2021 onwards, I have been tackling Health Disorder and Health Issue Courses. This may take 3 years or longer.

6. Empowerment objective - for laypeople to have an understanding of the issues involved in BREAST SELF-EXAMINATION. My PEP TALK today is entitled: BREAST SELF-EXAMINATION – TO DO OR NOT TO DO. This is part of the Health Issue Course. Health Issue Breast Self-Examination: TO DO or NOT TO DO

7. Breast self-examination or BSE is examining one’s own breasts. The other phrase that is being used interchangeably to mean the same thing is self breast examination (SBE). Health Issue Breast Self-Examination: TO DO or NOT TO DO

8. What are the issues associated with BSE? The main issue is whether BSE should be used to screen for early detection of breast cancer. The other issues are: - being afraid to do BSE and - accuracy worry of doing BSE by Filipino women. Health Issue Breast Self-Examination: TO DO or NOT TO DO

9. First issue: whether BSE should be used to screen for early detection of breast cancer. In the Internet, one sees reports that BSE is not or no longer recommended as part of the breast cancer screening. Yet, one still sees a lot of websites continuing to advocate and educate women in doing BSE. What should it be – to do or not to do BSE? Health Issue Breast Self-Examination: TO DO or NOT TO DO

10. First issue: whether BSE should be used to screen for early detection of breast cancer. Current ARGUMENTS for NOT TO – NOT TO DO BSE - NO LONGER RECOMMENDING BSE: The USPSTF (US Preventive Service Task Force) recommends against clinicians teaching women how to perform breast self-examination. The Canadian Task Force on Preventive Health Care does not recommend breast self-examinations. Health Issue Breast Self-Examination: TO DO or NOT TO DO

11. First issue: whether BSE should be used to screen for early detection of breast cancer. Current ARGUMENTS for NOT TO – NOT TO DO BSE - NO LONGER RECOMMENDING BSE: Before the advent of mammography, BSE was included in the screening guidelines for breast cancer. With the advent of mammography, BSE as well as clinical breast examination (CBE), one that is done by a physician, is no longer recommended as part of the breast cancer screening. Health Issue Breast Self-Examination: TO DO or NOT TO DO

12. First issue: whether BSE should be used to screen for early detection of breast cancer. Current ARGUMENTS for NOT TO – NOT TO DO BSE - NO LONGER RECOMMENDING BSE: The reasons forwarded: BSE has not shown to be effective in detecting early breast cancer. BSE has not shown to be effective in improving survival or reduce deaths for women who have breast cancer. There are a lot of false positive outcomes that lead to unnecessary tests. There are a lot of false negative outcomes that delay detection of breast cancer. Health Issue Breast Self-Examination: TO DO or NOT TO DO

13. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: My personal stand is that BSE should still be a screening tool for breast cancer together with other screening tools like clinical breast examinations by a breast specialist who is an expert on palpation of the breast and mammography. Health Issue Breast Self-Examination: TO DO or NOT TO DO

14. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: Here are my reasons. BSE, as a screening tool, can detect breast cancer just as clinical breast examination (CBE), mammography, and other instrumental or laboratory diagnostic tests can. Health Issue Breast Self-Examination: TO DO or NOT TO DO

15. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: There may be differences in the diagnostic yield and diagnostic accuracy among the different screening methods but BSE for sure can still detect breast cancer. That this is so is supported by the fact that before the advent of mammography, BSE was being recommended as a screening tool because it could detect breast cancer no matter what. Health Issue Breast Self-Examination: TO DO or NOT TO DO

16. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: Self-detection of something unusual in the breasts by a lay person can initiate a medical consultation which eventually can lead to a diagnosis of breast cancer, if that something unusual turns out to be cancer. Health Issue Breast Self-Examination: TO DO or NOT TO DO

17. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: BSE can detect breast cancer in the early stage as long as the patients will report their findings to the breast specialists early enough. Health Issue Breast Self-Examination: TO DO or NOT TO DO

18. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: By the way, the breast specialists that I am specifically referring to, are the general surgeons or breast surgeons who do a lot of palpation of the breasts in the clinics and who have gained expertise in the process, especially when they validate their clinical breast examination findings with the operative findings in case the patients undergo operations. Health Issue Breast Self-Examination: TO DO or NOT TO DO

19. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: The breast surgeons are the expert palpators of the breast and have the highest accuracy in detecting breast cancer by physical examination more than the gynecologists, the medical oncologists and the radiation oncologists. Health Issue Breast Self-Examination: TO DO or NOT TO DO

20. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: BSE can and has detected breast cancers in the localized stage and stage 1 (less than 2-cm tumor). Its limitation is that it will not be able to detect through palpation a breast cancer tumor that is less than 5 mm. Bigger than this, usually 1 cm size, it will be able to detect through palpation. Health Issue Breast Self-Examination: TO DO or NOT TO DO

21. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: Stage 1 is still considered as early staged cancer. It is true that mammography can detect breast cancer tumor at a microscopic level up to a size smaller than 5 mm. That is the advantage of mammography over BSE. However, this advantage of mammography does not and should not negate the ability of BSE to detect early breast cancer (as early as stage 1). Health Issue Breast Self-Examination: TO DO or NOT TO DO

22. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: Those patients with early breast cancers detected with BSE who were treated early have better survival rates that those patients who presented with advanced disease. Thus, BSE is able to reduce breast cancer deaths if it detected cancers in the early stage (localized and stage 1) and the patients subject themselves to early treatment. Health Issue Breast Self-Examination: TO DO or NOT TO DO

23. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: It is a given that no diagnostic procedures and tests are 100% accurate all the times. BSE has its own share or percentage of non-diagnostic yield and inaccuracy. Health Issue Breast Self-Examination: TO DO or NOT TO DO

24. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: The other diagnostic procedures and tests such as clinical breast examination and mammography likewise have their own share or percentage of non-diagnostic yield and inaccuracy in terms of false positive and false negative findings. Health Issue Breast Self-Examination: TO DO or NOT TO DO

25. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: BSE’s false positive findings may lead to unnecessary tests. This negative situation or limitation of false positive findings is also present in clinical breast examination (CBE) and mammography. A BSE false-positive finding can be corrected right away without undue harm to the patient by the CBE by a breast specialist. Health Issue Breast Self-Examination: TO DO or NOT TO DO

26. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: BSE’s false negative findings may lead to delay in detection of early breast cancer. Again, this negative situation or limitation is also present in clinical breast examination and mammography. Health Issue Breast Self-Examination: TO DO or NOT TO DO

27. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: A BSE false-negative finding can be corrected soon or early enough if BSE is being practiced on a regularly close-interval basis, such as monthly. A false-negative finding may be changed to a true-positive findings in subsequent BSEs. Health Issue Breast Self-Examination: TO DO or NOT TO DO

28. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: The advantage of BSE, if done regularly usually at the recommended monthly interval, is that it can detect a false negative result earlier because of repeated close-interval examinations compared to clinical breast examination and mammography, whose repeated examinations are usually done at longer interval, usually ranging from 6 months to one year. Health Issue Breast Self-Examination: TO DO or NOT TO DO

29. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: A reason forwarded against BSE as well as CBE to favor mammography is that BSE and CBE have a lot of inaccurate findings. The truth is mammography also has a lot of inaccurate findings. Health Issue Breast Self-Examination: TO DO or NOT TO DO

30. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: There may be studies that show mammography has a higher diagnostic accuracy rates than BSE and CBE. The reports should be taken with caution. Health Issue Breast Self-Examination: TO DO or NOT TO DO

31. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: Mammography are being done by radiologists who are trained in reading mammography plates. They are specialists in a sense. So one expects higher diagnostic accuracy rates than laypeople doing BSE and general physicians doing CBE. Health Issue Breast Self-Examination: TO DO or NOT TO DO

32. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: If the laypeople are well-trained in BSE and if the CBE are done by breast palpator specialists, the figures in the diagnostic accuracy rates may not differ much among the three screening methods. Health Issue Breast Self-Examination: TO DO or NOT TO DO

33. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: Another reason to support my personal stand: In those medical societies recommending against the use of BSE in favor of mammography, there is always a statement of “however” like so: Health Issue Breast Self-Examination: TO DO or NOT TO DO

34. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: “However, it is very important for women to be aware of how their breasts normally look and feel and to report any changes to a health care provider right away. This is especially important if a woman notices a breast change at some point in between her regular mammograms.” Aren’t these statements referring to BSE? Isn’t this a recognition and appreciation of the ever-present value and usefulness of BSE? Why do they have to make guideline statements excluding BSE? Health Issue Breast Self-Examination: TO DO or NOT TO DO

35. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: From my perception, on the new changes in the screening guidelines of USPSTF (US Preventive Service Task Force) and Canadian Task Force on Preventive Health Care, I think these came about because mammogram has been reported to be better than BSE and CBE in terms of capability of earlier detection of breast cancer and more reduction of breast cancer deaths as a result of earlier detection. On this basis, the BSE and CBE were junked totally as screening methods. I don’t think this should be the case. Health Issue Breast Self-Examination: TO DO or NOT TO DO

36. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: For me, BSE and CBE can still be used as screening methods for detection and also early detection for that matter of breast cancers together with mammography and other screening methods that may be found useful now and in the future. The screening methods do not have to be one only or exclusive, such as just mammography. They can be done in combination and in sequence. Health Issue Breast Self-Examination: TO DO or NOT TO DO

37. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: First, remember, history wise, before the advent of mammography, BSE was included in the screening guidelines for breast cancer. It had served the community or population well in detecting breast cancer early and as a consequence of this early detection, it has reduced breast cancer deaths. Health Issue Breast Self-Examination: TO DO or NOT TO DO

38. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: Second, despite the advent of mammography, up to now, majority of breast cancer patients have detected their breast cancers not through mammography and CBE but through BSE, most of the time, accidentally and at times, because of a developed health habit of doing regular BSE. Health Issue Breast Self-Examination: TO DO or NOT TO DO

39. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: Third, there is no national program that requires and/or subsidizes a screening mammography for all citizens. For those who cannot afford out-of-pocket payment of mammography and do not subscribe to mammography (just as not everybody subscribes to COVID19 vaccination), an alternative has to be offered. BSE is the still the most practical alternative as it costs nothing to every citizen. The things left to do are that it should be inculcated and taught well to the population. Health Issue Breast Self-Examination: TO DO or NOT TO DO

40. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: For me, I repeat my position: The screening methods do not have to be one only or exclusive, such as just mammography. They can be done in combination and in sequence. Health Issue Breast Self-Examination: TO DO or NOT TO DO

41. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: It should start with BSE, then CBE (by a breast specialist) and then mammography for the high-risk population (particularly those with a family history of breast cancer). Health Issue Breast Self-Examination: TO DO or NOT TO DO

42. First issue: whether BSE should be used to screen for early detection of breast cancer. ARGUMENTS for TO DO – TO DO BSE – STILL DO BSE: The BSE carries no expense on the part of the citizen or patient. It is simple and can be done repeatedly, anytime, and anywhere. It should be taught and practiced well by the citizens or patients. It should be taught by the breast specialists. Health Issue Breast Self-Examination: TO DO or NOT TO DO

43. Second issue: Afraid of doing BSE by Filipino women. In my medical practice during the past 40 years, I have encountered a significant number of Filipino adult women who have expressed their fear of doing BSE (mind you, this is different from declaring they don’t know how to do BSE as a reason for not doing or wanting to do BSE – this will be the third issue to be discussed below). Health Issue Breast Self-Examination: TO DO or NOT TO DO

44. Second issue: Afraid of doing BSE by Filipino women. One specific reason forwarded is they are afraid to find something fearsome, particularly breast cancer. I don’t know the technical term for this phobia, maybe, xenophobia – fear of the unknown. Health Issue Breast Self-Examination: TO DO or NOT TO DO

45. Second issue: Afraid of doing BSE by Filipino women. This situation is present in real life, not only for breast cancers but also for other diseases. They are afraid to do self-examination of their own bodies because of fear of finding something fearsome. Health Issue Breast Self-Examination: TO DO or NOT TO DO

46. Second issue: Afraid of doing BSE by Filipino women. Such unfounded fear may lead to late detection of breast cancer regardless of what screening methods are being recommended (CBE and mammography included). People with this kind of fear or attitude will not subject themselves to any kind of screening methods. Health Issue Breast Self-Examination: TO DO or NOT TO DO

47. Second issue: Afraid of doing BSE by Filipino women. What is the solution here? Education, persuasion, and psychotherapy if indicated. Health Issue Breast Self-Examination: TO DO or NOT TO DO

48. Second issue: Afraid of doing BSE by Filipino women. Another reason forwarded for being afraid to do BSE by the Filipino women is the belief that touching or palpating the breast may cause breast cancer. This is a myth that has arisen from the belief that trauma or a bump is a cause of breast cancer. A bump on the breast does not cause breast cancer. Health Issue Breast Self-Examination: TO DO or NOT TO DO

49. Second issue: Afraid of doing BSE by Filipino women. The background story behind the myth is that the painless unnoticeable cancer has been in the breast even before the bump. One day, when the bump occurs on the breast that contains the cancer, the person reflexly touches her breast and lo and behold, the cancer is discovered. This is origin of this myth believing that the bump caused the breast cancer. It is not true a bump on the breast or touching or palpating the breast can cause breast cancer. Health Issue Breast Self-Examination: TO DO or NOT TO DO

50. Second issue: Afraid of doing BSE by Filipino women. What is the solution here? Education and persuasion. Health Issue Breast Self-Examination: TO DO or NOT TO DO

51. Third issue: They don’t want to do BSE because they don’t know how to it. Very superficial reason but this is a common reason presented !!! There may be a deeper cause though, probably, afraid to find something fearsome and believing that doing palpation can cause breast cancer. Health Issue Breast Self-Examination: TO DO or NOT TO DO

52. Third issue: They don’t want to do BSE because they don’t know how to it. What is the solution here? Resolve deeper causes first. Then convince the laypeople of the usefulness of BSE. Once they are convinced, teach them properly. Health Issue Breast Self-Examination: TO DO or NOT TO DO

53. Before going to how to do BSE, some essential pointers to remember: All women should start developing a habit of doing BSE as early as age 20 as part of their preparedness program in detecting breast cancer in case one unfortunately develops in their bodies. Breast cancer is still rare in this age group. It starts coming out at age 30 to 40. So, at age 20, there is a lead-time of 10 years in developing BSE as a health habit in detecting early breast cancer. Health Issue Breast Self-Examination: TO DO or NOT TO DO

54. Before going to how to do BSE, some essential pointers to remember: BSE consists of inspection (looking at anything unusual on the externals of the breasts) and palpation (feeling the breasts for an abnormal mass). Health Issue Breast Self-Examination: TO DO or NOT TO DO

55. Before going to how to do BSE, some essential pointers to remember: In palpation, one has to differentiate lumpy breast tissues from a real mass which is medically called dominant mass (a more-or-less round or oval hump with a feel that is different from the surrounding normal breast tissues). If there is palpated dominant mass, automatically it is considered as a red flag (for further investigation as it signifies an abnormality). Health Issue Breast Self-Examination: TO DO or NOT TO DO

56. Before going to how to do BSE, some essential pointers to remember: Health Issue Breast Self-Examination: TO DO or NOT TO DO

57. Before going to how to do BSE, some essential pointers to remember: For menstruating women, it is usually advisable to do BSE a few days after the last day of the mense to avoid hormonal swelling of breast tissues during mense being mistaken for a dominant mass. This is aside from avoiding the discomfort induced by palpating a breast that is usually sensitive during time of menstruation. Health Issue Breast Self-Examination: TO DO or NOT TO DO

58. Before going to how to do BSE, some essential pointers to remember: For non-menstruating women, it is usually advisable to choose either the first or last day of the month for doing a monthly BSE for ease of memory. Health Issue Breast Self-Examination: TO DO or NOT TO DO

59. Before going to how to do BSE, some essential pointers to remember: The first goal of BSE is to look and feel for anything unusual on the breasts. Once something unusual is found, either it is closely monitored for persistence or it is brought to the attention of a breast specialist already. The self-monitoring of doubtful unusual findings can be done with repeated BSE on the same day, subsequent days or the next month. Health Issue Breast Self-Examination: TO DO or NOT TO DO

60. Before going to how to do BSE, some essential pointers to remember: The second goal of BSE is to try to interpret the unusual findings as much as able. If unable to and a red flag is present, consult a breast specialist right away. Health Issue Breast Self-Examination: TO DO or NOT TO DO

61. Before going to how to do BSE, some essential pointers to remember: There are many techniques as there are authors. Choose one that is simple and practical to do as long as the end-points or goals are reached, especially the first goal. Health Issue Breast Self-Examination: TO DO or NOT TO DO

62. How to Do Breast Self-Examination – by ROJoson https://www.youtube.com/watch?v=lkqI3aVkhLs Health Issue Breast Self-Examination: TO DO or NOT TO DO

63. How to Do Breast Self-Examination – by ROJoson Visual Inspection (LOOKING) Expose the upper body. In a standing position, face a mirror to view entire chest and breasts. Health Issue Breast Self-Examination: TO DO or NOT TO DO

64. How to Do Breast Self-Examination – by ROJoson With both arms down and then raised over the head, look for anything unusual on the breasts! Health Issue Breast Self-Examination: TO DO or NOT TO DO

65. How to Do Breast Self-Examination – by ROJoson Look for changes in the contour of the breasts and armpits, such as bulge, skin dimpling, and flattening! Health Issue Breast Self-Examination: TO DO or NOT TO DO

66. How to Do Breast Self-Examination – by ROJoson Look for unusual changes on the skin of the breasts, such as redness and lesions! Health Issue Breast Self-Examination: TO DO or NOT TO DO

67. How to Do Breast Self-Examination – by ROJoson Manual Palpation (FEELING) In a standing position, with one arm raised over the head, using the flats of 2 to 3 fingers (2nd to 4th fingers) of the other hand, gently but firmly palpate the entire breast on the side where the arm is raised. Health Issue Breast Self-Examination: TO DO or NOT TO DO

68. How to Do Breast Self-Examination – by ROJoson Feel for anything unusual in the breast and feel for a possible presence of a dominant mass! A dominant mass is an unusual density distinct from the surrounding breast tissue with a felt margin or border which connotes a three dimensional lump. Health Issue Breast Self-Examination: TO DO or NOT TO DO

69. How to Do Breast Self-Examination – by ROJoson Cover the entire area of the breast by going one quadrant at a time until all four quadrants of the breast are palpated. Health Issue Breast Self-Examination: TO DO or NOT TO DO

70. How to Do Breast Self-Examination – by ROJoson Before palpating the armpit, gently squeeze the nipple for possible presence of discharge. Health Issue Breast Self-Examination: TO DO or NOT TO DO

71. How to Do Breast Self-Examination – by ROJoson When palpating the armpit, put the arm down to have a lax or slack skin fold. Place the palpating fingers initially at the uppermost portion of the armpit. Then, gently but firmly press against the chest wall in the armpit and slowly glide the fingers downward to feel for anything unusual and to feel for a possible presence of a dominant mass! Health Issue Breast Self-Examination: TO DO or NOT TO DO

72. How to Do Breast Self-Examination – by ROJoson Repeat the same procedures for the other breast, nipple, and armpit. Health Issue Breast Self-Examination: TO DO or NOT TO DO

73. How to Do Breast Self-Examination – by ROJoson Interpretations of Findings on BSE Health Issue Breast Self-Examination: TO DO or NOT TO DO

74. How to Do Breast Self-Examination – by ROJoson Interpretations of Findings on BSE - NO dominant breast mass found on physical examination in patients complaining of breast mass and in patients coming for breast check  = normal or fibrocystic changes - Breast pain with NO dominant breast mass = fibrocystic changes Health Issue Breast Self-Examination: TO DO or NOT TO DO

75. How to Do Breast Self-Examination – by ROJoson Interpretations of Findings on BSE - Nonsanguinous (not red) nipple discharge with NO dominant breast mass = fibrocystic changes -  Sanguinous (red) nipple discharge with NO dominant breast mass = intraductal papilloma Health Issue Breast Self-Examination: TO DO or NOT TO DO

76. How to Do Breast Self-Examination – by ROJoson Interpretations of Findings on BSE - Focal erythema or redness and tenderness with NO dominant breast mass = mastitis Health Issue Breast Self-Examination: TO DO or NOT TO DO

77. How to Do Breast Self-Examination – by ROJoson Interpretations of Findings on BSE - Focal erythema or redness with a tender, fluctuant dominant breast mass = breast abscess Health Issue Breast Self-Examination: TO DO or NOT TO DO

78. How to Do Breast Self-Examination – by ROJoson Interpretations of Findings on BSE - cystic mass with no signs of malignancy – Macrocyst Health Issue Breast Self-Examination: TO DO or NOT TO DO

79. How to Do Breast Self-Examination – by ROJoson Interpretations of Findings on BSE SUSPECT CANCER: - Presence of a dominant breast mass with telltale (or giveaway) signs of malignancy (signs of local invasion of the breast mass on the adjacent tissues and signs of spread) - Presence of sanguinous nipple discharge with an accompanying dominant mass Health Issue Breast Self-Examination: TO DO or NOT TO DO

80. How to Do Breast Self-Examination – by ROJoson Interpretations of Findings on BSE CANCER SUSPECT Signs of local invasion of the breast mass on the adjacent tissues Fixation to the adjacent tissues such as the overlying skin inclusive of the nipple and areola and the underlying tissues such as chest muscles and ribs. Skin changes over the mass that are suggestive and indicative of local invasion such as ulcerations and fungation . Health Issue Breast Self-Examination: TO DO or NOT TO DO

81. How to Do Breast Self-Examination – by ROJoson Interpretations of Findings on BSE CANCER SUSPECT Signs of spread presence of palpable ipsilateral axillary lymph node and supraclavicular lymph node. Health Issue Breast Self-Examination: TO DO or NOT TO DO

82. Do not listen / be discouraged by the negative recommendations on BSE. Do not be afraid to do BSE as it will not cause breast cancer. Do not be afraid to do BSE because of fear of finding breast cancer. If there is breast cancer, with BSE, it will be detected early enough. Do not simply say you don’t know how to do BSE to justify your reason for not doing BSE. You have to learn how to do it because of its usefulness. You can easily learn it as it is simple. Summary Take Away Health Issue Breast Self-Examination: TO DO or NOT TO DO

83. Develop BSE as a health habit. Make it as your first and mainstay screening and detecting armamentarium for breast cancer. You can complement BSE with CBE, mammography and other screening methods as needed and indicated. Do not rely solely on mammography and even CBE as they may give a false-negative finding at the time of examination and if you do monthly BSE, you may be able to discover a dominant mass that may appear before the next mammography. This way, you are able to discover a dominant mass early. Summary Take Away Health Issue Breast Self-Examination: TO DO or NOT TO DO

84. Doing regular BSE is an investment for your breast health. Nobody knows when breast cancer will strike. Do monthly BSE so that once breast cancer strikes, you can detect it early enough. With early recognition and early treatment, your chances of cure will be high. Summary Take Away Health Issue Breast Self-Examination: TO DO or NOT TO DO If you don’t do BSE AND if a breast cancer appears and is already in the advanced stage, you will be blamed for the situation. You did not love yourself and your body enough.

85. BSE as a health habit is simple and without cost. It can be repeated anytime without added cost. It can be done anytime and anywhere. It can detect breast cancer and other breast diseases. It can detect early breast cancer as long it is done regularly and properly and as long as it is reported to a breast specialist early enough. Consult a breast specialist right away once a dominant mass is detected during BSE. Summary Take Away Health Issue Breast Self-Examination: TO DO or NOT TO DO

86. Be always in touch with reliable medical information on fundamentals and generalities in medical management of breast disorders especially cancer. Take Away in relation to Patient Empowerment Knowledge is power; it gives power. Use the 4Ks of Patient Empowerment: Kaalaman , Kakayanan , Karapatan and Kapangyarihan to gain greater control over decisions in management of your breast health. Health Issue Breast Self-Examination: TO DO or NOT TO DO

87. Empowerment objective - for laypeople to have an understanding of the issues involved in BREAST SELF-EXAMINATION. Health Issue Breast Self-Examination: TO DO or NOT TO DO