When teaching the breast self examination the nurse should inform the woman that it is best to perform the exam is which of the following times?

Monthly breast self-examination (BSE) is an  important part of health care for all women in every stage of life.

This is one physical examination you can do yourself, in the privacy of your own home.

Women can discover breast changes themselves through self-exams, so this is an important health routine to establish.

In addition to BSE, women should get regular breast examination by  their health care provider. Women should have annual mammograms starting at age 40.

Doing these steps have been shown to improve the chances of early detection of breast cancer.

Step by step

First, it is important that you learn the normal characteristics of your breast tissue. No two women are the same. What is normal for another woman may not be normal for you.

It is a good idea to have your health care provider show you the proper procedure for BSE. At the same time, they can explain what you are feeling in the breast tissue, so you will be able to notice changes from month to month when you perform BSE on your own.

Set aside a scheduled time each month for BSE. If you are still menstruating, the best time for BSE is 2 to 3 days after your period ends, when your breasts are less likely to be tender and swollen.

If you have gone through menopause, whether naturally or surgically, pick a specific day of the month for this routine. It is very important that you make BSE a lifetime habit.

Visual inspection

Stand in front of a mirror with your upper body unclothed, and press both hands behind your head.

Look for changes in the shape, color and size of your breasts. Check for dimples of the skin or “pulling in” of the nipples. Check for scaling or a rash on your nipples.

Next, place your hands on your hips and tighten the chest muscles by pressing firmly inward while looking for any change from your breasts’ usual appearance. Perform this step while leaning slightly forward, then again while standing upright.

Physical examination

You may use 1 of 3 different methods — the circular method, the “wheel spokes” method, or the grid method.

During breast self-exam, be sure to use the fat pads of the fingertips of the 3 middle fingers.

• Circular method
  Use the hand opposite the breast you are examining. Beginning at the outermost top of your breast, press the flat portions of the 2nd, 3rd, and 4th fingertips into your breast. Moving in small circles slowly around your breast, work toward the nipple. Press firmly to feel deep tissues and gently to feel tissues under the skin. Be sure to cover the entire breast without skipping any areas. Repeat for your opposite breast.
• “Wheel spokes” method
  Imagine that your breast is divided into pie-shaped sections, much like spokes divide a wheel. Begin at the outermost top of the breast. Press the flat portions of the fingertips into your left breast, moving first toward the nipple, then away from the nipple. When you complete that section, slide your fingers slightly to the next area and repeat the process gradually moving around your entire breast. Repeat for your opposite breast.
• Grid method
  Begin at the innermost portion of the breast, near the breastbone. With the flat portions of the fingertips, move down your breast pressing firmly and gently. Slide your fingers slightly and move up your breast, then down, and so forth, until the entire breast area has been examined. Repeat for the opposite breast.

It is important that you choose the method that’s most comfortable for you, and use the same method each month.

Whichever method you use, do not skip any areas of the breast. Check for lumps, thickening, or any change from the previous examination.

Lying down

To examine your left breast, using one of the 3 methods mentioned, lie flat on your back with a small pillow or a folded towel under your left shoulder. Raise your left arm over your head.

Use the flat portions of the 2nd, 3rd, and 4th fingertips of your right hand to examine the left breast.

Press firmly to feel deep tissues and more gently to feel tissues under the skin.

Repeat the entire procedure for the right breast.

In addition, be sure to check the area between the upper outer breast and your armpit as well as the armpit itself. Check the area just above your collarbone for enlarged lymph nodes.

Pay special attention to the area between the breast and your armpit, including the armpit itself. Check the area just above your collarbone for enlarged lymph nodes.

In the shower

The next part of breast self-examination is performed in the shower, where the soapy, wet surface of the skin can make it easy to feel lumps.

Breast self-examination in the shower is important because masses in the upper part of the breast are easier to detect while standing upright; masses in the lower part may be felt more easily while lying down.

Place your left hand behind your head and, with the flat portions of the 2nd, 3rd, and 4th fingertips of the right hand, examine your entire left breast using 1 of the methods described. Repeat for your right breast.

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 (non-cancerous) 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, don’t wait. See your health care provider right away — even if you have had a negative mammogram in the past.

Breast self-exam, or regularly examining your breasts on your own, can be an important way to find a breast cancer early, when it’s more likely to be treated successfully. While no single test can detect all breast cancers early, Breastcancer.org believes that performing breast self-exam in combination with other screening methods can increase the odds of early detection.

Over the years, there has been some debate over just how valuable breast self-examination is in detecting breast cancer early and increasing the likelihood of survival. For example, a 2008 study of nearly 400,000 women in Russia and China reported that breast self-examination does not have a meaningful impact on breast cancer survival rates and may even cause harm by prompting unnecessary biopsies (removal and examination of suspicious tissue). Because of the ongoing uncertainty raised by this and other studies, the American Cancer Society no longer recommends breast self-exam as a screening tool for women with an average risk of breast cancer.

Breastcancer.org still believes that breast self-examination is a useful and important screening tool, especially when used in combination with regular physical exams by a doctor, mammography, and in some cases ultrasound and/or MRI. Each of these screening tools works in a different way and has strengths and weaknesses. Breast self-exam is a convenient, no-cost tool that you can use on a regular basis and at any age. We recommend that all women routinely perform breast self-exams as part of their overall breast cancer screening strategy.

Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.

Here's what you should look for:

• Breasts that are their usual size, shape, and color

• Breasts that are evenly shaped without visible distortion or swelling

If you see any of the following changes, bring them to your doctor's attention:

• Dimpling, puckering, or bulging of the skin

• A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)

• Redness, soreness, rash, or swelling

Now, raise your arms and look for the same changes.

Step 3

While you're at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).

Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.

Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.

Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you've reached the deep tissue, you should be able to feel down to your ribcage.

Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in step 4.

Don’t 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 (not cancer). There are a number of possible causes of non-cancerous breast lumps, including normal hormonal changes, a benign breast condition, or an injury.

Don’t hesitate to call your doctor if you’ve 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.

Know what to expect. 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. Both an ultrasound and a mammogram are typically recommended to evaluate a lump in women who are over age 30 and not pregnant or breastfeeding. If further testing is needed, your doctor may recommend additional imaging with MRI (magnetic resonance imaging), MBI (molecular breast imaging), and/or a biopsy. He or she may also refer you to a breast specialist (typically, a breast surgeon) for further evaluation.

Make sure you get answers. It’s 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 you’re not comfortable with the advice of the first doctor you see, don’t hesitate to get a second opinion.

Make it routine. The more you examine your breasts, the more you will learn about them and the easier it will become for you to tell if something has changed. Try to get in the habit of doing a breast self-examination once a month to familiarize yourself with how your breasts normally look and feel. Examine yourself several days after your period ends, when your breasts are least likely to be swollen and tender. If you are no longer having periods, choose a day that's easy to remember, such as the first or last day of the month.

Get to know your breasts' different “neighborhoods.” The upper, outer area — near your armpit — tends to have the most prominent lumps and bumps. The lower half of your breast can feel like a sandy or pebbly beach. The area under the nipple can feel like a collection of large grains. Another part might feel like a lumpy bowl of oatmeal.

Start a journal where you record the findings of your breast self-exams. This can be like a small map of your breasts, with notes about where you feel lumps or irregularities. Especially in the beginning, this may help you remember, from month to month, what is “normal” for your breasts. It is not unusual for lumps to appear at certain times of the month, but then disappear, as your body changes with the menstrual cycle (if you are still menstruating).