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