To Complete The Examination
Explain to the patient that the examination is now finished and provide them with privacy to get dressed.
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
Summarise your findings.
Example summary
Today I examined Mrs Smith, a 64-year-old female. On general inspection, the patient appeared comfortable at rest and there were no objects or medical equipment around the bed of relevance.
Closer inspection of the chest did not reveal any scars or breast abnormalities.
Palpation of the breast did not reveal any masses and there was no regional lymphadenopathy.
In summary, these findings are consistent with a normalbreastexamination.
For completeness, I would like to perform the following further assessments and investigations.
What Does A Lump In Your Breast Feel Like
What does a breast lump feel like? Breast tissue in and of itself can feel somewhat lumpy and sponge-like, so it can be hard to know if what youre feeling is an actual lump or just normal breast tissue. A breast lump will feel like a distinct mass thats noticeably more solid than the rest of your breast tissue.
When Should I Schedule A Clinical Breast Exam
Breast exams are best performed soon after your menstrual period ends, because your breasts will not be as tender and swollen as during your period. This makes it easier to detect any unusual changes. If you have stopped menstruating, schedule the yearly exam on a day that’s easy for you to remember, such as your birthday.
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Physical Exam While Standing Up
People often do a standing exam in the shower because the skin is easier to examine when slippery.
Use the following steps to perform a standing check:
How To Perform A Breast Self
PHILADELPHIA — Around one in eight women and one in 833 men will develop invasive breast cancer in their lifetime. Breast cancer is the second most fatal type of cancer for women in the United States, next to lung cancer. It’s important to assess your personal risk of breast cancer, as it can be hereditary. Be familiar with what is normal for your body and continue giving yourself a breast exam each month to be safe.
We talked with Dr. Kristin Brill, Helen Nichter, advanced practical nurse , and Stacie Cipparone, licensed practical nurse of Jefferson Breast Care Center, to explain the importance of breast self-exams and the best ways to perform one.
What is a breast self-exam?
A breast self-exam is something that anyone can perform in the privacy of their own home to check to see if there are any abnormalities in their body. Helen Nichter reminds us that all bodies are different, and it is important to understand what is normal for your body and to know when there are any changes.
Dr. Kristin Brill recommends that anyone over the age of 25 begins to give themselves a monthly breast self-exam. Because both men and women are susceptible to breast cancer, both should be completing self-exams. These are best to perform in the shower, as water can help to guide your hands. Another option is to do your exam while looking in the mirror.
How do you give a breast self-exam?
What are the next steps if you do find something?
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What To Do If You Find A Lump
Dont panic if you think you feel a lump in your breast. Most women have some lumps or lumpy areas in their breasts all the time, and most breast lumps turn out to be benign . There are a number of possible causes of non-cancerous breast lumps, including normal hormonal changes, a benign breast condition, or an injury.
Dont hesitate to call your doctor if youve noticed a lump or other breast change that is new and worrisome. This is especially true for changes that last more than one full menstrual cycle or seem to get bigger or more prominent in some way. If you menstruate, you may want to wait until after your period to see if the lump or other breast change disappears on its own before calling your doctor. The best healthcare provider to call would be one who knows you and has done a breast exam on you before for example, your gynecologist, primary care doctor, or a nurse practitioner who works with your gynecologist or primary care doctor.
Make sure you get answers. Its important that your doctor gives you an explanation of the cause of the lump or other breast change and, if necessary, a plan for monitoring it or treating it. If youre not comfortable with the advice of the first doctor you see, dont hesitate to get a second opinion.
Perform A Manual Inspection While You Are Standing
Next, use your right hand to manually examine your left breast for lumps, knots, thickened areas and other unusual changes. Using the pads of your three middle fingers, press on every part of your breast and underarm area. Follow a circular pattern to help ensure that you dont miss any areas. Gradually increase the pressure you apply from light to firm. Gently squeeze your nipple to check for discharge. Then, use your left hand to manually examine your right breast using the same techniques.
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Can I Rely On Breast Self
Mammography can detect tumors before they can be felt, so screening is key for early detection. But when combined with regular medical care and appropriate guideline-recommended mammography, breast self-exams can help women know what is normal for them so they can report any changes to their healthcare provider.If you find a lump, schedule an appointment with your doctor, but dont panic 8 out of 10 lumps are not cancerous. For additional peace of mind, call your doctor whenever you have concerns.
Medically Reviewed on April 15, 2020
Why Do You Need A Breast Exam
Performing a monthly self breast exam is key to familiarizing yourself with your breasts and being able to promptly recognize changes that could indicate cancer. While they should not be considered a replacement for annual mammograms, self breast exams can help you detect abnormalities in the months between preventive care visits.
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How To Do A Self Breast Exam
Breast cancer can be highly treatable and has a high survival rate when caught in its early stages. Knowing how to perform a breast cancer self-exam can help you identify lumps and determine whether you need to see a medical provider for treatment.
Continue reading to learn how to give yourself a breast cancer exam and what to do next if you discover one or more lumps.
How To Do A Breast Self
Check the OUTER HALF of your right breast. Lie down and roll on to your left side to examine your right breast. Place your right hand, palm up on your forehead. Your breast should lie as flat on your chest as possible. It may be easier and more comfortable if you put a pillow behind your shoulder or back.
Using the flat pads of your three middle fingersnot the tipsmove the pads of your fingers in little circles, about the size of a dime. For each little circle, change the amount of pressure so you can feel ALL levels of your breast tissue. Make each circle three timesonce light, once medium, and once deepbefore you move on to the next area.
Start the circles in your armpit and move down to just below the bra line. Then slide your fingers overjust the width of one finger and move up again. Dont lift your fingers from your breast as you move them to make sure you feel the entire area. Continue this up-and-down vertical strip patternfrom your collarbone to just below your bra lineuntil you reach the nipple.
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Where Are Breast Cancer Lumps Usually Found
Breast cancer lumps are usually found in the upper outer quadrants of each breast, Mata says.
The best way to locate the UOQ of the breast is to visualize your breast as a clock. When checking your left breast, the UOQ is in the 9 oclock to 12 oclock position. When checking your right breast, the UOQ is in the 12 oclock to 3 oclock position.
Breast cancer lumps can be found anywhere in the breast. However, it helps to know that the majority of lumps are in the UOQ.
Palpation For Axillary And Supraclavicular Lymphadenopathy
- The axillary lymph glands form a three-sided pyramid whose apex is in the narrow gap between the first rib and the axillary vessels
- In order to feel for axillary lymphadenopathy, the patients pectoral muscles need to be relaxed
- To examine the right axilla the examiner should hold the patients right elbow with their right hand and take the weight of their arm whilst palpating with the left hand and vice versa. Alternatively, the patient can rest their hands on the shoulders of the examiner.
- Place your hand into the axilla, and using your three middle fingers move them in small circles as you would to palpate the breast
- Move upwards from the base of the axilla palpating along the lateral chest wall to feel for nodes lying centrally or medially
- Work your way upwards ensuring you cover the entire area of the axilla and push the tips of your fingers upwards and inwards to palpate at the apex of the axilla
- Small shotty glands may be felt in thin patients and are not significant. Lymph nodes containing metastases are usually hard and discrete but they can mat together as they enlarge and become tethered or fixed to the skin
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How To Do A Breast Self Exam
This article was co-authored by Carrie Noriega, MD. Dr. Noriega is a Board Certified Obstetrician & Gynecologist and medical writer in Colorado. She specializes in womens health, rheumatology, pulmonology, infectious disease, and gastroenterology. She received her MD from the Creighton School of Medicine in Omaha, Nebraska and completed her residency at the University of Missouri – Kansas City in 2005.There are 10 references cited in this article, which can be found at the bottom of the page. This article has been viewed 210,515 times.
Breast self-exams are an optional screening tool to check for early signs of breast cancer. Performing these exams monthly can help you familiarize yourself with the look and feel of your breasts so that you can more easily detect changes. Though breast self-exams were once thought to be essential to screening for breast cancer, they are now considered a helpful, optional tool.
Breast Awareness And Knowing Your Normal
So where does this leave us seven years later?
The answer is that experts want individuals to shift the focus from breast “self-exam” to breast “self-awareness.”
Years ago, what we found was that many women were concerned about technique when they practiced self-exams, says Spring Piatek, an advanced practice nurse at the Northwestern Medicine High Risk Breast Clinic in Winfield, Illinois. They were concerned about subtle lumps or bumps which were normal breast tissue. They would raise concerns with provider and there would be a lot of unnecessary exams, visits, and calls.
Instead, healthcare professionals are committed to demystifying the breast self-exam.
In short, their message remains: Know your body.
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Enhancing Healthcare Team Outcomes
Breast exams may be performed by many clinicians including nurses. However, it is important to understand that current guidelines do not recommen regular clinical breast exams for cancer screening for women in any risk group. However, the women should be educated on the importance of changes to to the typical appearance and texture of their breasts and report any changes to their doctor right away.
What To Do If You Have A Lump In Your Breast
Dont hesitate to call your doctor if youve noticed a lump or other breast change that is new and worrisome. This is especially true for changes that last more than one full menstrual cycle or seem to get bigger or more prominent in some way. If you menstruate, you may want to wait until after your period to see if the lump or other breast change disappears on its own before calling your doctor. The best healthcare provider to call would be one who knows you and has done a breast exam on you before for example, your gynecologist, primary care doctor, or a nurse practitioner who works with your gynecologist or primary care doctor.
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What Is The First Test To Evaluate A Lump In Breast
At an appointment to evaluate a breast lump, your doctor will take a health history and do a physical exam of the breast, and will most likely order breast imaging tests. Ultrasound is often the first or only imaging test used to evaluate a lump in women who are under age 30 or are pregnant or breastfeeding.
What To Look For In A Nipple
Nipples: Check for any physical changes such as a sudden inversion, scaling, redness, itching , swelling, or discharge. Vein patterns: Look for a noticeable increase in size or number of veins compared to the other breast. Continuous itching: Itching which is not relieved by topical lotions or medications.
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What Does A Breast Lump Feel Like
If there is a lump on your breast, it will usually feel harder than other parts of your breast. However, some people with dense or cystic breasts may experience lumps. Breast consistency can also fluctuate around menstrual cycles.
It is best to speak with a doctor to rule out breast cancer if you find a lump on your breast or if you have dense breasts.
How To Check Your Breasts While Standing Up
2. Manual inspection while standing up: With your shirt and bra removed, use your right hand to examine your left breast, then vice versa. With the pads of your three middle fingers, press on every part of one breast. Use light pressure, then medium, then firm. Feel for any lumps, thick spots or other changes.
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Arms Above The Head Whilst Leaning Forward
Finally, complete your inspection by asking the patient to place their hands behind their head and lean forward so that the breasts are pendulous.
This position exposes the entire breast and will exaggerate any asymmetry, skindimpling or puckering.
- Inspect breasts whilst pendulous, looking for asymmetry and puckering
How Do I Do A Breast Self
The techniques for a self-exam are similar for everyone. If you choose to do one, follow these steps:
In the mirror:
In the shower:
Lying down:
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What Should I Look For In A Breast Self
If you get regular periods, the best time to do a breast self-exam is after your period. Your breasts are less likely to be swollen, lumpy, or tender at that time.
If you donât get a period or have irregular ones, pick a day of the month that youâre unlikely to forget and do it then. It should only take you a few minutes.
Look for:
- Any changes in your breasts, including their look, feel, or size
- Changes in how your nipples look or feel
- Dimpling or puckering on the breast skin
- Hard or thick lumps underneath the breast skin or deep within the tissue
- Pain in one breast or one spot
- Fluids or discharge from a nipple
- Nipple or other parts of your breast pulling inward
- Rashes in or around your breast
- Swelling in one or both breasts
- Warmth, redness, or dark spots on one or both breasts
Changes In The Breast
It is important that you see your health care provider if you detect a lump or change in the breast, such as nipple discharge, change in texture, dimpling of the skin, or pulling in of the nipple.
Eighty percent of all lumps found are normal tissue, benign cysts, or benign masses. Only your health care provider can determine the reason for the change.
If you notice a change in your breast tissue, dont wait. See your health care provider right away even if you have had a negative mammogram in the past.
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