SELF BREAST EXAMINATION (SBE)

Breast cancer is one of the commonest cancers in adult females. It accounts for the second commonest cause of cancer related deaths. The life time risk of developing breast cancer in adult females is 1 in 8 according to the Western studies.

Early detection of the cancer leads to early diagnosis and intervention leading to a better outcome. Females who do not have symptoms can undergo the process call screening to detect early cancers.

The procedure of screening includes

Self-Breast Examination Clinical Breast Examination Mammography

Self Breast Examination

Clinical Breast Examination

Clinical breast examination is done by an experienced clinician. The clinician will be able to identify any suspicious areas or lumps in the breast. An experienced clinician will be able to identify a lump slightly less than a centimeter in size.

Mammography

Mammography is a special x-ray taken on the breast with subjecting the patient to a minute amount of radiation. This can identify small suspicious areas and subject them to further evaluation.

Females especially after the age of forty years should undergo self breast examination (SBE). This as explained by the terminology is systematic examination of the female breast by the patient herself.

The process includes inspection as well as systematic palpation of the breast. Inspection includes looking for the symmetry of breast, skin changes such as redness, dimpling etc.… This can be done by standing in front of a mirror. For the purpose of palpation the breast can be divided in to quadrants

Gentle palpation should be done with the flat palmar aspect of your hand.

Cancers tend to be common in the outer upper quadrants of the breast.

By performing self breast examination, one would familiarize with her own texture of the breast and this will help her to identify any changes early. This is important not only to asymptomatic patients but also to patients who had cancer in one side of their breasts. These patients can do self-breast examination on the other side to detect changes early. Based on the current practices it is recommended for a female to perform self-breast examination monthly after the age of forty. It is important for the health care professionals to give clear instructions about the examination technique and the pros and cons.

If an abnormality is found during the self breast examination, the patient should seek advice from a clinician. The clinician will perform clinical breast examination. If there are any concerns, the patient will be subjected to the process of “Triple Assessment”.

The triple assessment consists of following after Self-Breast Examination

Clinical breast examination

Imaging studies

Needle biopsy / Core biopsy

Imaging studies include Mammography of both breasts and ultrasound study of both breasts. Ultrasound is a non-invasive and an investigation without radiation. Both these investigations can detect early cancers such as few millimetres in size. Finally any suspicious areas found in the imaging investigations will be subjected to biopsy, which is taking part of the area out by a special needle and examining them under the microscopy by a pathologist. This will confirm the diagnosis of the suspicious lump.

Dr Udaya Samarajeewa MBBS, MD- Surgery, MRCS (Eng.)

Consultant General Surgeon