Applied lessons are best for breast self-exam
The best way to teach women breast self-exam is to have them practice on themselves under professional guidance, says Tricia Smith, RN, MS, ANP, clinical nurse specialist in the Comprehensive Breast Center at Madison-based University of Wisconsin Hospital and Clinics.
"A woman really needs to be taught by a nurse, nurse practitioner, or physician how to do a breast self-exam. I tell them they are looking for changes, not necessarily breast lumps for lots of women have breast lumps. Women need to know what is normal breast tissue for them so they can identify changes," says Smith.
While teaching this skill is easiest in an exam room at a medical center, it can be accomplished in an outreach setting as well. Peggy Watson, RN, OCN, Canscreen clinician at St. Joseph’s Hospital of Atlanta developed the Clinical Breast Exam Teaching Project with a $5,000 grant from the Dallas-based Susan G. Komen Breast Cancer Foundation.
Watson schedules days to teach women one-on-one breast self-exam techniques at schools, churches, and businesses free of charge. When a group agrees to have a breast cancer screening, Watson sends them a contract that lists their duties and a schedule. The organization sponsoring the screening is responsible for promoting the event and scheduling appointments for breast exams every 30 minutes throughout the day.
Each woman who comes to the appointment fills out a quick 10-question personal breast history that includes questions about pain and lumps in the breast. Watson uses a private room or office at the facility to do the exams.
"As I do the clinical breast exam, I teach the woman how to do it at home. Also, I discuss what her personal risk factors may be and what she can do to help decrease those risks," says Watson. Women also learn when to have a mammogram.
When a demonstration is not possible, a breast model works well, says Smith. Using a model, women can learn what normal breast tissue feels like and when a mass might signal cancer.
Kristina Pavlou, director of public education for Chicago-based Y-Me National Breast Cancer Organization, uses a breast model with hidden lumps to teach her outreach classes how to do correct breast self-exams. "The lumps aren’t to show what cancer feels like but to give the idea of what is normal and what isn’t," explains Pavlou.
When Watson does community breast cancer screenings, nine out of 10 women say they have never been taught to do a correct breast self-exam, she says.
"Even those women who do monthly breast self-exams say no one taught them how to do it properly," says Watson.
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