Summarize the
guidelines for the early detection of breast cancer by developing a
teaching plan for breast self-examination for
patients.
ANSWER:
Breast cancer is one of the most common cancer among
women. Breast examinations : self- examination, clinical
examination and mamogram are the main methods used in the
diagnosis.
Breast-self-examination is a procedure in which the
individual self examines the breast for any abnormalities and it
remains as a useful tool in detecting breast cancer early , when it
is most treatable.
WHO SHOULD DO IT?
- women at age 20 and older are highly recommended to
perform BSE.
WHEN SHOULD IT BE DONE?
- the best tome to perform a BSE is a week after the
onset of periods.
- it is advised to fix a date in a month for monthly
examination in post menapausal women and follow the same time every
month to perform BSE.
When educating a patient about
breast- self-examination (BSE) , ask the patient ot follow the 7
P's of BSE which comprises of all the essential points that an
individual should follow while performing the
examination.
The 7 P's stands for the following:
1. POSITIONS :
- Standing position (for looking at the breast): the
female should stand infront of a mirror, undressed till the waist
in the following three positions
- Arm
relaxed at the sides
- Arms raised above head and,
- Holding arms on the waist.
The patient should look for the following: size and
shape of breast, dimpling, color and texture of nipples . Also note
any retraction of nipples amd change in direction of the nipple
point. Also check the night cloths and inner wear for any stain
.
- Lying down position ( to feel the breast ): Ask the
patient to lie down on her back and place the right hand behind her
head (if right breast is being assessed) and to keep pillows or
rolled towel for support under the shoulder. This position helps in
easier palpation as there is even distribution of the breast tissue
over the chest wall
The patient should feel for the following by
palpating using the pads of three middle fingers : any lumps or
abnormal masses and for any soarness or tenderness.
2. PERIMETER (where to feel ):
- The area to be palpated includes all of the breast
region including the nipple and arm-pit.
3. PALPATION :
- Breast should be palpated in small circular motion
using the pad of three middle fingers.
- Patient can use a lotion or powder as it will help in
easy sliding of fingers from one spot to the other or the female
can perform it while in the shower, as fingers move smoothly over
the soapy skin.
4. PRESSURE (how deep to feel) :
- Ask the patient to use three levels of pressure from
light to deep as she has to feel the breast all the way
through tissue to the ribs.
5. PATTERN OF SEARCH ( palpate from outer
quadrant towards the nipple) :
- Ask the patient to consider her breast as a face on a
clock. Ask the women to palpate in small circular motion starting
at 12 O' clock and slowly move towards 1 O' clock and continue the
same until she reach 12 O' clock again to complete one circle. Then
move 1 inch towards the nipple and complete another circle the same
way we did before. Ask the patient to continue this pattern until
the entire breast is felt. Remind the patient to palpate the
upper-outer quadrant as this is where the lumps are felt
in most of the cases.
6. PRACTICE WITH FEEDBACK:
- Ask the patient to learn BSE from a doctor
or a nurse and redemonstrate it to them to know if you are doing it
right. This will also help the patient know what is normal for
her.
7. PLAN FOR ACTION:
- Ask the patient to perform the BSE on a monthly basis
and if any abnormalities are noted approach doctor for further
help.