ROJoson PEP Talk: Breast Self-Exam: A Must-Do for all Filipina (Lecture)

1. BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Empowerment
objective - for
laypeople to have an
essential
understanding of
BREAST SELF-EXAM
AS A MUST-DO IN
ALL FILIPINA in their
health management.
My PEP TALK today is
entitled:
BREAST SELF-
EXAM: A MUST-
DO FOR ALL
FILIPINA

2. Contents
• What is a BREAST SELF-EXAM (BSE)?
• Why is BSE a must-do for all Filipina?
• Why is screening mammogram NOT a must-do
for all Filipina?
• How to do BSE?
• How to interpret the findings in BSE?
• What is ROJoson’s advocacy program on BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Disclaimer:
ROJoson PEP Talk
contains ROJoson’s
Thoughts,
Perceptions,
Opinions and
Recommendations
(TPORs) culled from
experiences of other
professionals and
ROJoson.

3. What is a BREAST SELF-EXAM (BSE)?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

4. What is a BREAST SELF-EXAM (BSE)?
BSE is examination of one’s own breasts,
usually through
inspection (looking at one’s own breasts) and
palpation (touching and feeling with fingers one’s
own breasts)
for
anything unusual
any abnormality, any disease.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

5. Why is BSE a must-do for all Filipina?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

6. Why is BSE a must-do for all Filipina?
Breast self-exam (BSE) is a must for all Filipina
who love themselves and their bodies and who
are concerned with their breast well-being.
(Note: Not wellness as wellness is focused on
physical health but well-being which encompass
wellness and include physical, emotional and
psychological health.)
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

7. Why is BSE a must-do for all Filipina?
Also, BSE is a must because the most dreaded
disease of the breast or breast cancer can strike
anytime and at any age to all Filipina, young and
old, as long as they are still alive and until they
die of other diseases.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

8. Why is BSE a must-do for all Filipina?
Also, BSE is a must because breast cancer is the
most common cancer in the Philippines among
the Filipino women (Filipina).
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

9. Why is BSE a must-do for all Filipina?
Also, BSE is a must as no Filipina should rely
solely or only on a physician or a breast specialist
in their goal to achieve breast well-being.
Also, BSE is a must as no Filipina should rely
solely on laboratory tests such as mammography
and ultrasound, even if done yearly or every 2
years, in their goal to achieve breast well-being.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

10. Why is BSE a must-do for all Filipina?
Lastly, BSE is a must because it is simple to do; it costs nothing; and it is
the primary and foremost early breast cancer detection tool.
The physician’s clinical examination of the breast and breast laboratory
tests such as mammography and ultrasound are secondary and should
be preceded by a BSE.
At present, majority of breast cancers among the Filipina are discovered
through BSE and not with physician’s clinical examination of the breast
and breast laboratory tests.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

11. Why is BSE a must-do for all Filipina?
Thus,
BSE is a must-do for all
Filipina.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

12. Why is BSE a must-do for all Filipina?
All Filipina should do BSE starting at the age when they can
be taught how to do BSE and how to interpret findings on
BSE.
This age can start at the adolescence or teenage period.
Adolescence is the phase of life between childhood and
adulthood, usually from ages 10 to 18. This is the period in
which it is considered an important time for laying the
foundations of good health.
BSE should be done until the end- or near-end of life as
breast cancer can occur up to the oldest age.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

13. Why is BSE a must-do for all Filipina?
All Filipina should not just rely on physician’s clinical
examination of the breast and breast laboratory tests such
as mammography and ultrasound.
This practice cannot be sustained because of the
inconvenience and cost involved which will just result to
an IRREGULAR AND HAPHAZARD program for promoting
breast well-being.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

14. Why is screening mammogram NOT a must-do for
all Filipina?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

15. Why is screening mammogram NOT a must-do for
all Filipina?
Lately (August 2023), it has been reported in
JAMA that:
Current evidence does NOT substantiate the claim
that common cancer screening tests save lives by
extending lifetime.
This includes mammography.
https://jamanetwork.com/journals/jamainternalmedicine/
article-abstract/2808648A
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Screening
mammogram can be
done in Filipina with
high-rsk for breast
cancer (strong family
history of breast
cancer).
SELECTIVE ONLY!
NOT ALL! NOT
ROUTINE!
Mammography does
not replace BSE!

16. Why is screening mammogram NOT a must-do for all
Filipina?
Mammography is associated with a lot of uncommitted
readings (BIRADS – 0); false-positive readings; at times,
false-negative readings.
A lot of times, these have led to undue anxiety for the
patients; unnecessary added procedures; and more
expense.
Thus, screening mammogram is NOT a must-do for all
Filipina.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

17. How to do BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

18. How to do BSE?
To be effective in achieving its goal of promoting
breast well-being and detecting breast cancer
early enough if it develops, BSE must be done
correctly and regularly, at least once a month.
The essential objective of BSE is to look for
anything unusual. If anything unusual is found,
an attempt at interpretation can be done. A
breast specialist is consulted early as warranted.
NOTE: it takes only a few minutes to do BSE.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

19. How to do BSE?
When to do BSE?
For menstruating women, BSE is recommended to be done 7 to 10 days
after the last day of mense. (to avoid hormonal swelling of breast
tissues during mense being mistaken for a dominant mass AND to avoid
the discomfort induced by palpating a breast that is usually sensitive
during time of menstruation)
For non-menstruating women, first or last day of the month is chosen.
It can be done during bath time or any other time.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

20. How to do BSE?
Where to do BSE?
BSE can be done in any private place such as in a
bathroom during bath time.
Standing up or lying down?
It can be done either standing up or lying down.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
It takes only a few
minutes to do BSE.

21. How to do BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Visual Inspection (LOOKING)
Expose the upper body.
In a standing position, face a mirror to view entire
chest and breasts.

22. How to do BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
With both arms down and then raised over the
head,
look for anything unusual on the breasts!

23. How to do BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Look for changes in the contour of the breasts and
armpits, such as bulge, skin dimpling, and
flattening!

24. How to do BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Look for unusual changes on the skin of the
breasts, such as redness and lesions!

25. How to do BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
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.

26. How to do BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
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.

27. How to do BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Cover the entire area of the breast by going one
quadrant at a time until all four quadrants of the
breast are palpated.

28. How to do BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Before palpating the armpit, gently squeeze the
nipple for possible presence of discharge.

29. How to do BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
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!

30. How to do BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Repeat the same procedures for the other breast,
nipple, and armpit.

31. How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

32. How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Take note of the difference between lumpy breast
surface and dominant mass (the real mass – a red
flag if present).

33. How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
- NO dominant breast mass found on physical
examination in persons complaining of breast
mass and in persons coming for breast check =
normal or fibrocystic changes
- Breast pain with NO dominant breast mass =
fibrocystic changes

34. How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
- Nonsanguinous (not red) nipple discharge with
NO dominant breast mass = fibrocystic
changes
- Sanguinous (red) nipple discharge with NO
dominant breast mass = intraductal
papilloma

35. How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
- Focal erythema or redness and tenderness with
NO dominant breast mass = mastitis

36. How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
- Focal erythema or redness with a tender,
fluctuant dominant breast mass = breast
abscess

37. How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
- cystic mass with no signs of malignancy –
Macrocyst
Cystic means containing fluid.
A cystic mass is one that is depressible.

38. How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
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

39. How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
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.

40. How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
CANCER SUSPECT
Signs of spread
• presence of palpable ipsilateral axillary
lymph node and supraclavicular lymph
node.

41. What is ROJoson’s advocacy program on BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

42. io
What is ROJoson’s advocacy program on BSE?
Dr. ROJoson’s advocacy program on BSE dated as
far back as 1982, a year after he graduated from
his general surgery residency program from the
Philippine General Hospital and started managing
patients with breast concerns.
He believes BSE is the MOST PRACTICAL way and
very USEFUL and ECONOMICAL at that, to detect
breast cancers among Filipina (breast cancers
being very common among the Filipina).
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

43. What is ROJoson’s advocacy program on BSE?
With his more than 40 years of experiences in the management of Filipina
with breast concerns, he does NOT subscribe to using routine (regular)
mammogram nor ultrasound of the breasts as a screening tool for breast
cancers.
Main reasons: He has seen
• A lot of inconclusive reports on mammograms (BIRADS 0)
• A lot of false-positive reports on ultrasounds of the breasts
• False-negative reports
Secondary reason: Most patients cannot sustain a practice of regular
mammogram and ultrasound because of inconvenience and cost.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

44. What is ROJoson’s advocacy program on BSE?
Lately (2023), ROJoson’s stance on routine screening with mammogram
has been validated –
Ukraine’s adoption of early diagnosis program over screening
mammogram with the blessing of WHO
“Better than screening: with WHO’s help Ukraine chose a cost-efficient
policy to prevent breast cancer” WHO publication
https://www.who.int/europe/news/item/08-03-2021-better-than-
screening-with-who-s-help-ukraine-chose-a-cost-efficient-policy-to-
prevent-breast-cancer
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

45. What is ROJoson’s advocacy program on BSE?
Lately (2023), ROJoson’s stance on routine screening with mammogram
has been validated –
A 2023 paper published in JAMA –
Estimated Lifetime Gained With Cancer Screening Tests
Current evidence does not substantiate the claim that common cancer
screening tests save lives by extending lifetime. This includes
mammography.
https://jamanetwork.com/journals/jamainternalmedicine/article-
abstract/2808648A
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

46. What is ROJoson’s advocacy program on BSE?
In 2022, ROJoson created a program called BSE Awards in which he would
give cash awards as incentives to FILIPINA who would do regular BSE for
at least 9 months.
The primary objective of the Club is to promote early detection of breast
cancers among Filipino women.
Awards were given to 65 BSE promoters and practitioners (a total of P38,
700.00) in December 2022.
The Awards is ongoing in 2023.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

47. BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

48. What is ROJoson’s advocacy program on BSE?
Plans for 2024 (will initiate this before the end of
2023):
Entice / invite Filipina to learn how to do BSE and
how to interpret findings and then take an Online
Learning Cum Evaluation Test Exercise (OLETE).
OLETE passers will get Certificates of
Commitment and Accomplishment, Certificates
of Proficiency and Certificates of Mastery.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

49. What is ROJoson’s advocacy program on BSE?
Plans for 2024 (will initiate this before the end of
2023):
Entice / invite Filipina to learn how to do BSE and
how to interpret findings and then take an Online
Learning Cum Evaluation Test Exercise (OLETE).
OLETE passers will get Certificates of
Commitment and Accomplishment, Certificates
of Proficiency and Certificates of Mastery.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

50. What is ROJoson’s advocacy program on BSE?
Plans for 2024 (will initiate this before the end of
2023):
Entice / invite Filipina to learn how to do BSE and
how to interpret findings and then take an Online
Learning Cum Evaluation Test Exercise (OLETE).
OLETE passers will get Certificates of
Commitment and Accomplishment, Certificates
of Proficiency and Certificates of Mastery.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

51. What is ROJoson’s advocacy program on BSE?
Plans for 2024 (will initiate this before the end of
2023):
Entice / invite Filipina to learn how to do BSE and
how to interpret findings and then take an Online
Learning Cum Evaluation Test Exercise (OLETE).
OLETE passers will get Certificates of
Commitment and Accomplishment, Certificates
of Proficiency and Certificates of Mastery.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

52. Contents
• What is a BREAST SELF-EXAM (BSE)?
• Why is BSE a must-do for all Filipina?
• Why is screening mammogram NOT a must-do
for all Filipina?
• How to do BSE?
• How to interpret the findings in BSE?
• What is ROJoson’s advocacy program on BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Summary
Take Away

53. BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Summary
Take Away
BSE: A MUST-DO FOR ALL FILIPINA
• 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.

54. BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Summary
Take Away
BSE: A MUST-DO FOR ALL FILIPINA
• 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.

55. Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on BREAST SELF-EXAM.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions /
make better decisions on BREAST SELF-
EXAM AS A MUST-DO FOR ALL FILIPINA in
your health management.
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA

56. BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
Empowerment
objective - for
laypeople to have an
essential
understanding of
BREAST SELF-EXAM
AS A MUST-DO IN
ALL FILIPINA in their
health management.