INTRODUCTION:

“BREAST MILK IS THE BEST MILK” for Neonate

Breast, it is present only on mammalian pieces, i.e., which is giving milk to their child. It is the feministic characteristics of females. Breast secretes breast milk that is useful for neonates to prevent infection and maintain the health of the neonates.

“KEEPS A BREAST HEALTHY”

Good Breast health is one of the most important thing a person (female) could have. When you are healthy, you can enjoy the life anytime as you wish. Good breast health helps you look and feel you best.

“BE BRISK, TO AVOID RISK OF BREAST CANCER”

No women want to hear the words…”You have got breast cancer”. You definitely look better by having two breasts. And if you look better and feel better you will definitely live better. Thus, we have to learn how to improve our odds of not having breast cancer at all.

BSE gives you the tool that can improve your breast health, but it is up to you to use them. Make good breath health is a part of your day and part of your life, now and in the years to come.

Breast self-exams: One way to detect breast cancer

Breast self-exams — along with clinical breast exams and mammography — raise your awareness of your breast health. Breast self-exams, long advocated as essential for early breast cancer detection, are now considered optional.

What's stressed today is breast awareness, which involves being familiar with the normal consistency of your breasts and the underlying tissue.

Breast self-exams contribute greatly to breast awareness, teaching you how your breasts vary in sensitivity and texture at different times during your menstrual cycle and different stages of life. This sense of what's normal is known as breast familiarity.

Monthly breast self-examination (BSE) includes both looking and feeling over the entire breast and chest area. Women should use the pads, not the tips, of the three middle fingers when performing BSE. The time required to perform the exam varies with the size and features of a woman's breasts but usually only takes about 15 to 20 minutes each month. Women should be sure to examine the breasts in the same manner each month, check the entire breast and armpit area, and remember how the breasts feel from month to month. Some women prefer to keep small diary of their monthly breast self-exams.

It is good to be in the habit of breast self-examination (BSE) on a regular basis since early detection leads to early investigation and treatment. Women of all ages should perform self-examination since breast problems can occur at any age. The best time of the month to perform self-examination is after menstruation, when the breast tissue is softer and lumps are more likely to be felt. Immediately prior to menstruation the breast becomes naturally lumpy and often tender - features that can mask a problem. For women who are post-menstrual, with irregular periods or who have had hysterectomy, a suitable time should be chosen - for example the 1st day of the month. Examination more frequently than this, is probably not necessary and may lead to increased anxiety. A woman who regularly examines her breasts will get a very clear idea of her normal breast texture and consistency, and will help her to notice if something is different. Individual hospitals and specialists may advise slightly different methods, but the principles of BSE are the same.

How to do BSE?

There are two basic steps to conducting a BSE:

1. Visual Examination

2. Tactile Examination

Visual Examination

During the first part of the BSE, the visual examination, you look for changes in each breast. What is important in visual BSE is not the normal difference between your two breasts, but any change in one breast without a similar change in the other. The changes you have to look for include:

· Shape

· Size

· Contour or symmetry (is there a difference in the level between your nipples? Do both breasts look symmetrical?)

· Skin discoloration or dimpling

· Bumps/lumps – NOTE: normal lumpiness, like in the week before and of your menstrual cycle, will appear as very small and separate lumps like the texture of an orange.

· Sores or scaly skin

· Discharge or puckering of the nipple

· Dimple

· Ulceration

Stand in front of a mirror and look for the above changes in your breasts (from both a frontal and profile view) in 3 different positions:

1. With your arms raised

2. With your arms down at your sides

3. Bending forward

· with your hands on your hips and shoulders turned in

· with your arms relaxed hanging in front of you

Tactile Examination

This is the part of the examination when you need to feel your breasts for any changes. It is important to check the surrounding areas because breast cancer may be found in the lymph node tissue around the breast and underarm.

Begin by lying in bed. Place a small pillow or folded towel under your left shoulder and your left hand behind your head. Your shoulder should be raised high enough for your left breast to be center on top of your chest, falling neither to the center nor toward the armpit; this arrangement distributes the breast tissue as evenly as possible across the chest wall. If a breast is not properly flattened against the chest, it is difficult to feel a lump – particularly in the outer upper quadrant, where tissue is thickest (and where most cancers occur). Feel your breasts and surrounding areas, which include:

· the breast

· between the breast and underarm

· the underarm

· the area above the breast up to the collarbone and across to your shoulder

Use the pads (where your fingerprints are) of your three middle fingers on your right hand pressed together flat to check your left breast, and do the opposite for the right breast. You should press on your breast with varying degrees of pressure:

 light (move the skin without moving the tissue underneath)

 medium (midway into the tissue)

 hard (down to the ribs "on the verge of pain")

When using any of the 3 patterns, you should always be using a circular rubbing motion without lifting your fingers.

Patterns of breast self examination

Spiral: Begin with a large circle around the perimeter of your breast and make smaller and smaller circles as you work your way toward the nipple.

Wedges: Pretend your breast is divided into sections like triangular pieces of a cake, begin in the nipple area and feel your breast in a small circular motion within one section, then move on to the next wedge starting in the nipple area again.

Vertical or linear: Pretend your breast is divided into vertical stripes. Begin on the underarm area on one side and feel your breast in a small circular motion up and down in a zig zag pattern till the whole breast is covered. Then repeat the process for the right breast with your left hand.

What to feel for?

Carefully notice the "feel" of your normal breast structure, so that you can note at once any changes from what is usual for you. Many women have a normal thickening or ridge of firm tissue under the lower curve of the breast, at its attachment to the chest wall; also the large milk ducts can be felt as a ring of bumps at the outer edge of the areola. In very slender women, the bony prominences of the chest wall may be mistaken for chest tumours, as may enlarged milk glands, fat tumours, lymph nodes, or benign cysts. All such thickenings should be felt carefully during each monthly BSE, in order to distinguish normal conditions from potentially dangerous changes. Any lump or other change found in one breast only (especially in the upper outer quadrant) is more likely to be serious. If in doubt about ANY development, consult your doctor.

The Seven P's method

A similar method of self-examination is known as the Seven P's of BSE:

1. Position: Inspect breasts visually and palpate in the mirror with arms at various positions. Then perform the examination lying down, first with a pillow under one shoulder, then with a pillow under the other shoulder, and finally lying flat.

2. Perimeter: Examine the entire breast, including the nipple, the axillary tail that extends into the armpit, and nearby lymph nodes.

3. Palpation: Palpate with the pads of the fingers, without lifting the fingers as they move across the breast.

4. Pressure: First palpate with light pressure, then palpate with moderate pressure and finally palpate with firm pressure.

5. Pattern: There are several examination patterns, which each woman should use the one that is most comfortable for her. The vertical strip pattern involves moving the fingers up and down over the breast. The pie-wedge pattern starts at the nipple and moves outward. The circular pattern involves moving the fingers in concentric circles from the nipple outward. Don't forget to palpate into the axilla.

6. Practice: Practice the breast self-exam and become familiar with the feel of the breast tissue, so you can recognize changes. A health care practitioner can provide feedback on your method.

7. Plan: Know what to do if you suspect a change in your breast tissue. Know your family history of breast cancer. Have mammography done as often as your health care provider recommends.

For premenopausal women, BSE is best done at the same stage of their period every month to minimize changes due to the menstrual cycle. The recommended time is just after the end of the last period when the breasts are least likely to be swollen and tender. Older, menopausal women should do BSE once a month, perhaps on the first or last day of every month.

Limitations

About eight in ten lumps discovered by BSE are harmless. Nevertheless, any abnormality thus detected should immediately be reported to a doctor. Though most breast cancers are detected by women, BSE should be combined with an annual examination by a doctor for better chances of detection. Women can easily miss a breast lump that an expert can find. For the same reasons it is better to learn BSE from an expert.

BSE is not a replacement for more trustworthy techniques like mammography or an examination using MRI

Pros and cons of breast self-exams

One benefit of breast self-exams is the potential to identify and treat a cancerous breast lump while it's still small and in an early stage of development. On the flip side, however, you might need a biopsy to evaluate an area of concern. If the biopsy results are noncancerous (benign), you might feel that you've undergone an invasive procedure unnecessarily. Breast self-exams may also be challenging if you have normally lumpy (fibrocystic) breasts.

Breast self-exams alone don't reduce the number of deaths from breast cancer. Breast self-exams can miss tumors, as can other methods of screening. That's why it's important to rely on more than one method to screen for breast cancer. A combined approach to breast cancer screening — including breast self-exams, clinical breast exams, mammography and magnetic resonance imaging (MRI) for certain high risk women — increases your chances of finding breast cancer at an early, treatable stage.

REFERENCES:

1. Aheloff. D., (1995) “Clinical Oncology”, Churchill Livingstone, New York.

2. Beare Myers (1998), “Adult Health Nurisng”, 3^rd edition, Mosby publications, Missouri..

3. Daftary, Shrish N., and Chakaravarthy, Sudip. (2005). “Manual Of Obstetrics”, New Delhi: Elsevier, A division of Reed Elsevier India Private Limited.

4. Bailey. T., (April 2000) “Nurse’s Role In Promoting Breast Awareness”, Nursing Standards.

5. Baron. R.H and Walsh. A.H., (August 1998), “Nine Facts Everyone Should Know About Breast Cancer”, American Journal of Nursing.

6. Baxter. P., (June 2001), “Should Women Be Raitinely Taught breast self examination To Screen For Breast Cancer”, Preventive Health Care.

7. Clarkes. S., (Aug. 1999), “Breast Self Examination Training”, Cancer Nursing.

8. Coleman. P., (Sep 91), “Breast Imaging Today & Tomorrow”, Nurse Practice Forum.

9. Foster. C., (Apr. 2001), “An Effective Manual On breast self examination”, World Health forum.

10. Breast self examination, Thina Thanthi, August 2008.

Online

1. http://online.sagepub.com/cgi/alerts

2. http://www.ncbi.nlm.nih.gov/pubmed.

3. http://www.newstrack india.com/new details/28000

Received on 20.07.2013 Modified on 10.08.2013

Asian J. Nur. Edu. and Research 3(4): Oct.- Dec., 2013; Page 258-261