Understanding BSE

BSE is a breast self-examination that aims to determine the presence or absence of breast cancer in
women. This examination is done by using a mirror and performed by women aged 20 years and over.
The primary indication of BSE is to detect the occurrence of breast cancer by observing the breasts from
the front, left and right sides, whether there are bumps, discoloration, puttting noisy and discharge of
fluid or pus and blood (Olfah et al, 2013). American Cancer Society recommends that from the age of 20
years, women check her breasts every three years until the age of 40 years. Afterwards the examination
can be done once a year. Although before the age of 20 years a lump in the breast can be found, but the
potential malignancy is very small (Setiati, 2009).
Breast self-examination (BSE) is the development of a woman's concern for her own breast condition.
This action comes with special steps to detect early breast cancer. This activity is very simple and can be
done by all women without the need to feel embarrassed to the examiner, does not require a fee, and
for busy women only need to provide waktuna for about five minutes. No special time is required, BSE
is enough to do while bathing or while lying down. BSE should begin when a woman has
menstruation. The level of sensitivity (its ability to detect breast cancer) is about 20-30%
(Nisman, 20011).
Breast self-examination (breast self-examination) to detect breast cancer is the easiest and
cheapest way of knowing the lumps are likely to develop into malignant cancer. BSE or breast
self-check with regular merabanya is an important step for early detection of breast cancer. The
habit of being easy, cheap, fast, and effective to semangkin "recognize" and realize if there is
something abnormal in the breast.
Should not wait for a lump in the breast because if it had happened, then the possibility of
suffering from breast cancer stage 1 larger. Examination through ultrasound and mammography
should be done periodically. For women aged 50 years and over, it is recommended every year.
While the age below that, can be three years. Even so, if there is a lump, a breast cancer detected
from five women who feel there is only one bump (Olfah et al, 2013).
Breast self-examination (breast self-examination) is a breast self-examination to be able to find
any abnormal lumps. This check can be done alone without having to go to a health worker and
without having to pay a fee. The American Cancer Society in the breast cancer screning project
advocated a breast self-examination although no complaints are found

By doing early detection can reduce mortality by 25-30%. In doing early detection such as BSE
is necessary and interest
awareness of the importance of health to improve the quality of life and maintain the quality of
life for the better (Mulyani, 2013).
The shape of the breast usually changes before entering the menstrual period, usually payuadara
feels enlarged, soft, or there is a lump and return to normal when the menstrual period is
complete. The important thing is to recognize which changes are common and which are not
normal from the breast itself. Self-examination of breast self (BSE) on a regular basis to be able
to feel and recognize the curves of the breast so that if there is a change can be immediately
known. The best time to check your breasts is 7 to 10 days after your menstruation is over. At
that time, the breasts felt soft. Inaccurate examination is performed on the approaching and
during menstruation (Bustan, 2007).
BSE of the optinum is performed at about 7-14 days after the beginning of the menstrual cycle
because at that time the minimal fluid retention and the breasts are soft, not hard, swelling so that
if there is a penetration it will be easier to find (Mulyani, 2013).
2.1.2 Who Needs To Be BSE?
According to Nisman 2011, women are encouraged to do breast self-examination or Breast Self
Examination (BSE) to reduce trigger breast cancer incidence when performing BSE as follows:
1. Women of childbearing age: 7-8 days after menstruation
2. Postmenopausal women: at certain times of the month
3. Every woman over 20 years old needs to do breast self-examination (BSE) every month.
4. Women who are at high risk before reaching 50 years need to do mammography every year,
breast examination by doctors every 2 years.
5. Women aged between 20-40 years:
a. Early or basic mammogram between the ages of 35 to 40 years.
b. Perform breast testing on the doctor every 3 years.
6. Women aged between 40-49 years perform breast examination on the doctor and
mammography every 1-2 years.
7. Women over the age of 50 years of breast examination at the doctor and mamogarfi every
year.
2.1.3 Benefits of BSE
According to Nisman (2011) Early detection is a very important first step to find out early
existence of tumor or lump in breast so that can reduce death rate because of cancer disease. The
advantage of early detection is beneficial to increase the chances of survival in women with
breast cancer. Almost 85% of the disturbances or bumps are found by the patient alone through
the examination correctly. In addition, BSE is the easiest, fastest, cheapest, and simplest method
that can detect breast cancer early
Purpose BSE
According to Nisman (2011) BSE goal is very necessary to aim to reduce the incidence of breast cancer as
follows.
1. BSE only detects early breast cancer, not to prevent breast cancer. With the early detection of breast
cancer can be detected at an early stage so early treatment will extend the life expectancy of breast
cancer patients.
2. Lowering the death rate of patients due to cancer found in the early stages will provide a longer life
expectancy.
2.1.5 How to Check Your Own Breast (BSE)
According to Nisman (2011), Mulyani (2013), Bustan (2007), Sitorus (2006), Proverawati (2010) and
Olfah et al (2013) early detection of breast cancer can be done breast self-examination. The right time to
check your breast is one week after the menstrual period. If the menstrual cycle has stopped, it is
advisable to check the breast itself at the same time each month and the time required to do it no more
than 5 minutes. It is evident that 95% of women diagnosed in early stages of breast cancer survive more
than five years after diagnosis so that many doctors recommend that women undergo a breast self-
examination at menstruation, on days 7 to day 10 after day first menstruating at home on a regular
basis and suggesting an annual routine check to detect a lump in the breast. Breast self-examination can
be done at the age of 20 years less or more.
1. Open the shirt and undress your bra and stand upright in front of the mirror with both arms straight
down. Note the presence or absence of changes in the size and shape of your breasts, such as the curve
or wrinkles of the skin.

See Changes in Front of Mirror.

Look at the mirror, shape and balance of breast shape (symmetrical
or not). Way to do :
2.1 Phase 1 Picture Viewing Breast Shape in Mirror
See the changes in shape and magnitude, changes in the nipple, and skin of the breast in front of the
glass. Standing straight in front of the mirror, position both arms straight down beside the body. Notice
the shape and size of the breast, normal if the size of one with the other is not the same. Then, note
also the shape of the nipple and skin color. The average breast changes without our BSE. The changes to
watch out for are if the breasts are wrinkled, sunken inward, or protruding forward due to a bump.
Nipples that change positions where they should stand out, are even pulled in, with red, rough, and
painful.

2.2 Phase 2 Picture Check the Breast with Lifting

Second Hand
Examine the breast with your hands raised over your head. In order to see the skin retraction, the
attachment of the tumor to the muscles or the underlying fascia or abnormalities in both breasts. Go
back to observe the changes that occur in your breast, such as discoloration, tug, protrusion, wrinkles,
nipple changes or rough surface.

2.3 Picture Stage 3 Stand in Front of Hand Mirror Beside

Stand upright in front of the mirror with your right and left hand. Tilt your body to the right and left to
see changes in the breast.

2.4 Stage 4 Picture Stretching Section Muscles with Randomize

Waist

Stretching the chest muscles by putting your hands against your hips is meant to tense the muscles in
the axilla area. Then notice whether there are abnormalities as above. Still in such a position, bend
down and indicate whether there are any suspicious changes or abnormalities or nipples.
2.5 Phase 1 Picture Preparation BSE
At the start of the right breast, lie facing left by bending your knees. Put a pillow or bath towel that has
been folded under the right shoulder to raise the part to be checked. Then place your right hand under
your head. Use your left hand to examine the right breast. Use the palm of your fingers to check any
lumps or thickening. Check your breasts by using the Vertical Strip and Circular to form a 90 degree
angle.

2.6 Phase 2 Picture Breast Examination with Vertical Strip

Check all parts of the breast in a vertical way, from the collarbone at the top to the bra-line at the
bottom, and the midline between the two breasts to the midline of your armpits. Use your left hand to
start a massage on your armpits. Then turn and press firmly to feel the bump. Move your hands slowly
under the bra line with a light swivel and strong press in each place. At the bottom of the bra line, move
approximately 2 cm left and continue up towards the collarbone by twisting and pressing. Move up and
down following the massage and cover all the designated parts.

2.7 Picture Stage 3 Breast Inspection by How to Play

Starting from the top of your breasts, make a big spin. Move around the breasts by noticing the
incredible bumps. Make at least three small rounds to the nipple. Do it 2 times. Once with light
pressure and once with strong pressure. Do not forget to check the bottom of the areola mammae.
Breast pressure rotates clockwise with the flat plane of your fingers together. Starting from 12.00
on the nipple.
2.8 Phase 4 Image Examination of Fluid in Breast Putting
Use both hands, then press your breast to see any abnormal fluid from the nipple.
2.9 Stage 5 Checking the Underarms
Put your right hand to the side and feel your armpit aside and feel your armpit carefully, whether
it is palpable abnormal lump or not.
2.1.5.1 How to Conduct BSE
According to Bustan (2007) and Purnomo (2009) the steps of breast self-examination stage can
be done various kinds during the bath, standing in front of the mirror and lying bed to make your
kenya manan to do BSE in every month to reduce death due to breast cancer too late to detect
early breast cancer that is as follows:
1. During Bath
Lift one hand. Using one finger, move horizontally slowly into the place for each breast. Use your right
hand to examine the left and left hand to check the right breast. Check and look for hard lumps,
thickened in the breast.
2. Stand in front of the mirror
By lifting both hands up the head, turn the body slowly from the right side to the left side. Wrap your
waist, press down slowly downward to tense your chest muscles and refuse your breasts in the face. Pay
close attention to any changes such as the size, shape and contour of each breast. See also if there is
stiffness, indentation or nipple highlighted. Slowly, twinkle both nipples and notice if there is fluid out.
Check what fluid looks clear or contains blood.
3. Lie down
To check the right breast, place the pillow under the right shoulder and the right hand is placed behind
the head. Press your finger horizontally and move slowly in the form of a small sphere, starting from the
base of the payuadara. After one turn, the finger is moved 1 inch (2.5 cm) toward the nipple. Do the
rounds to check each part of the breast including the nipple. Repeat the same thing on the left breast by
putting a pillow under the left shoulder and left hand placed behind the head. try to feel the same there
exists any clumps below and along the top of the collarbone.

2.1.6 Problems Encountered During Delay in Recognition (Breast Self-Examination)

According to Olfah et al (2013), Setiati (2009), Nisman (2011), and Kasdu (2005) stated that if you do not
do screening and early detection with breast self-examination every month 5-7 days after menstruation
will find findings of breast cancer problems or abnormalities that occur in the breast as there have been
a number of signs to watch out for which indicate an abnormality in the breasts. The following may
indicate the presence of breast cancer specific signs of breast cancer as follows:
1. There is a small lump in the tissue around the breast is usually painless although 25% of cancer is
associated with a sense of discomfort.
2. Nipple folded inside.
3. Changes in texture or taste like skin discoloration and there are wrinkles on the skin of the breast.
4. Discomfort or regular awareness of one breast.
5. A change in the nipple or spontaneous removal of the nipple (rare).

6. Swollen lymph nodes under your spotted armpits are a sign of increased disease.
7. There is swelling, a hard, solid, painless lump, if pressed does not move in place, and only
palpable on one breast.
8. There are injuries such as blood or pus out of the nipple
9. Pain
10. There is swelling in the armpit or nipple area, such as itching, burning, and being attracted to
the inside
11. There is an injury in the armpit area.
2.1.7 What We Do When Finding a Lump
According to Nisman (2011) and Mulyani (2013) BSE was just performed by a small group of
women. It is estimated that only 25% to 30% of women who do breast self-examination well and
regularly every month. Generally this step is avoided because it creates a frightening image. First
realize that our BSE effort is for early-very early detection-so we have a big hope that the
problems we encounter are mild, treatable, and the healing can be done well. The second is to try
to calm down if you find a lump. Do not try massaging the lump because the massage will not
make a small lump, otherwise it can make the problem becomes more severe if this lump is a
problem or disease. The third is to immediately consult with the right doctor to get further
examination.
Mammography is a process of human breast examination using low-dose X-rays (generally ranging from
0.7 mSv). Through Mammography examination, the rate of kematia due to breast cancer can be reduced
to 30%. Mammography method, emitted X-rays is very small, so this method is relatively easy.
Mammography is a safe test that aims to see a problem in the female breast.
b. Biopsy
A test to take a small amount of tissue from the bump and the area around the lump. The tissue is sent
to the laboratory for testing, looking for changes that indicate the presence of cancer. The lumps or
changes found in the breast may be benign (not cancerous) or malignant (cancer) and if breast cancer
can be earlier then the woman may survive the disease better as well as many therapies for breast
cancer.
c. Diagnostic mammograms are performed when a woman has symptoms
symptoms of breast cancer or there is a lump in the breast and this mammogram takes longer because
the images taken are also more.
d. Digital mammogram to take an electronic picture of the breast and
store it directly on the computer. Recent research does not show that digital images are better at finding
cancer than in Sinar X films.

2.2 Breast Cancer

2.2.1 Definition of Breast Cancer
Breast cancer is a malignant tumor in the breast or one of the breasts, breast cancer is also a lump or a
single mass that is often present in the upper quadrant of the outer region, this lump is hard and
irregular shape and can be moved. Breast cancer (Carcinoma Mammae) is a malignant neoplasm disease
originating from parenchyma. Breast tissue consists of milk glands (milk drow gland), gland channel (milk
ducts), and breast support tissue (Olfah et al, 2013).
Breast cancer is known as slaha one cancer most commonly affects women. In addition, the prevalence
increase tendency can not be avoided. Moreover, breast cancer mortality is still high, especially in
developing countries, because of late diagnosis, which means also delayed pengobtan. All of this in turn
leads to cancer problems as a costly health problem (Bustan, 2007).

Leaflet lama

EXAMINATION OF OUR BREAST

1. Understanding BSE and Breast Cancer
Breast self-examination (BSE) is an early detection of breast cancer symptoms. This method is very
simple, but is expected to suppress the high rate of breast cancer sufferers, because early semkin
detected the faster the necessary treatment process.
Breast cancer is the presence of benjoln in the breast, ulcers, or wounds that do not heal, the fluid that
comes out of the nipple, and the pain in the breast. Nmun generally, this paudara cancer does not cause
pain so that the patient comes in late, especially when the age is old. (Abdurahman, et al., 2009).
2. Symptoms of Breast Cancer
Early symptoms of a lump usually felt different from the surrounding breast tissue, painless and usually
have an irregular edge.
In the early stages, if pushed by a finger the lump can be moved easily under the skin.
In advanced cancer. Can form a bump that bends or ulcers in the skin of the breast. Sometimes the skin
on the benjoln shrinks and looks like an orange peel.
Other symptoms that may be found:
- Bumps or mass in the armpits
- Changes in breast size or shape
- Exit abnormal fluid from the nipple (usually bloody or yellow to green, may also fester)
- Changes in skin color or texture of the breast, nipple, or aerola (dark brown area around the nipple)
- The breasts look reddish
- The skin around the scaly nipple
- Putting the milk pulled in or itchy
- Breast pain or swelling of one breast

At an advanced stage may arise bone pain, weight loss, swelling of the arm or ulceration of the
skin.
3. Risk Factors Breast Cancer

a. Age
Approximately 60% of breast cancers occur at the age of 60 years. The biggest risk is found in
women aged 75 years.
b. Never had breast cancer
Women who have had in situ cancer or invasive cancer have the highest risk for breast cancer.
After the affected breast lifted. Then the risk of cancer in healthy breasts increased by 0.5-1% /
year.
c. Family history of breast cancer
Women whose mothers, sisters or children have cancer, are three times more likely to have
breast cancer.
d. Genetic and hormonal factors
Tumor found two gene variants that seem to play a role in the occurrence of breast cancer,
namely BRCA1 and BRCA2. If a woman has one of these genes, then the chances of having
breast cancer are enormous. Other genes are also thought to play a role in the occurrence of
breast cancer is p53. BARD1, BARD2 and Noev2. This fact raises the notion that breast cancer
is caused by the growth of cells that are genetically damaged. Hormonal factors are also
important because the hormone triggers cell growth. High hormone levels during women's
reproductive years, especially if not interspersed by hormonal changes as pregnancy appear to
increase the chances of growth of cells that are genetically damaged and cause cancer.
e. Never had a non-cancer breast disease
The risk of breast cancer is somewhat higher in women who have had non-cancer breast disease
that causes an increase in the number of ducts and the occurrence of breast tissue abnormalities
(atypical hyperplasia).
f. Menarche (first menstruation) before the age of 12 years. Menopause after the age of 55 years,
the first pregnancy after the age of 30 years or have never been pregnant. The earlier menarche
the greater the risk of breast cancer. The risk of breast cancer is 2-4 times greater in women who
experience menarche before age 12 years. Similarly with menopause or first pregnancy. The
more menopause and early pregnancy the greater the risk of breast cancer.
g. Use of birth control pills or estrogen replacement therapy
Birth control pills can slightly increase the risk of breast cancer, which depends on the age of
duration of use and other factors. It is not known how long the effect of the pill will remain after
the pill is stopped. But estrogen replacement for more than 5 years seems to also slightly increase
the risk of breast cancer and the risk increases if pemakaiannnya longer.
h. Postmenopausal obesity
Obesity as a risk factor for breast cancer is debatable. Some studies suggest obesity as a risk
factor for breast cancer is likely due to high levels of estrogen in obese women.
i. Alcohol use
Alcohol consumption of more than 1-2 cups / day may increase the risk of breast cancer.
j. Chemical material
Some studies have suggested exposure to estrogen-like chemicals (contained in pesticides and
other industrial products) may increase the risk of breast cancer.
k. DES (diethylstilbestrol)
Women who take DES to prevent miscarriage have a higher risk of breast cancer.
l. Vision
The advent of venation (especially chestnut), in childhood may increase the risk of breast cancer.
m. Other risk factors

Several studies have shown that cervical cancer, ovarian cancer and colon cancer and family
history may increase the risk of breast cancer (Medicastore 2010).

4. Breast cancer prevention

a. Awareness of breast itself

b. Breastfeed the baby
c. If the lump determines, go to the doctor immediately
d. Find out if there is a history of cancer in the family
e. Consider alcohol consumption
f. Watch the weight
g. Exercise regularly
h. Reduce fatty foods
i. If more than 50 years, do breast screening regularly
j. Learn to relax (wibsono 2009)
5. Early Detection of Breast Cancer
a. Another method of early detection is BSE. Women over the age of 20 should regularly perform BSE
every month (the best time is a week after menstruation). Follow these steps:
1) Stand in front of the mirror and lift one arm of him over the head, check whether there is a change in
the breast and putting.
2) Lie down and systematically check / touch the breast with three fingers to feel the presence or
absence of a lump.
3) Massage putting to know the existence of fluids and check / rabaketiakwhether aa lump / swelling.
b. Panduaan on Breast screening
Under the age of 40 years
1) BE AWARE every month
2) Breast examination to the doctor every 3 years
3) Basic Mommagraphy
Age 40 and up
1) BE AWARE every month
2) Medical examination to doctor every 3 years
3) Basic mammography
Age 40 and up
1) BE AWARE every month
2) Payudar examination to the doctor every year
Age 40 to 49 years
1) Mammmorafi every month
Age 50 and above
1) Mammography every 2 years

6. Breast Cancer Treatment

Treatment of breast cancer can be various kinds. Depending on the condition or stage stages, also the
state of the patient. There are several methods of treatment from the medical world that are commonly
applied to breast cancer patients, among others as follows:
a. Lumpectomy
Lumpectomy is a procedure for removal of tumor tissue and some normal and surrounding tissues.
b. Masectomy
Masectomy is a scourge for women with breast cancer. It is a procedure of lifting the entire breast tissue
with cancer so that it no longer has breasts. The following types:
1) Preventive Mektectomy
Preventive masectomy is the way that applied to women who have genesis factor as breast cancer
sufferer carried out preventive action by lifting breast tissue so as not to appear another tumor on the
network.
2) Simple Masektomi
This is the procedure of lifting the entire breast tissue down to the nipple, while still maintaining the
lymph tissue. This procedure will also make the patient lose her breasts.
3) Modified Radical Masectomy
This procedure is practically a total mascotomy. Because it lifts the entire tissue and parts of the breast.
Even the lymph nodes under the armpit are removed, but the muscle tissue of the breast buffer is
maintained and can be removed. This procedure can be followed by implant breast reconstruction.
4) Radical Masectomy
Inoi way is the most total procedure of jeis masektomi. Whole breast tissue, lymph tissue, skin, support
muscles. Even to the muscle of the chest wall lifted.

c. Radiation Therapy
Radiation therapy is a therapeutic method by adding X-rays or other ion particles to the tumor.
d. Chemotherapy
Chemotherapy is a treatment using drugs given orally or injected. Chemotherapy commonly uses high-
dose drugs that work in cells.
e. Hormone Therapy
Hormone therapy is the administration of drugs as chemotherapy, but the drug given is a drug that
affects hormone production.
f. Turgeted Therapy
Turgeted Teraphy is a drug that is specifically targeted to inhibit the growth of certain proteins.
g. How Breast Self Examination (BSE)
Breast self-examination can be done by looking at changes in the presence of a mirror by looking at
changes in breast shape by lying down.
1) Phase 1
Watch your breasts in the mirror with the position of both arms straight down. Raise your hands behind
your head, moving your arms forward simultaneously. Examine whether on your breasts there are
lumps or shape changes.

2) Phase 2
Press your arms firmly on the hips, then move both arms and elbows forward while shrugging.
3) Stage 3
Raise your left arm. Touch the left breast with three right fingers tightened. Do the same examiner on
the right breast. Perabbaan can be done by gently pressing the breast but steady with a circular motion
clockwise, starting from the outside to the nipple. Movement of the fingers of the upper breast down,
and vice versa. Move your finger from the area around the nipple to the outer side of the breast.
4) Stage 4
Click on the area around the nipple. Observe the changes that occur including abnormal discharge.
5) Stage 5
Lie down with your left hand under your head, place a small pillow under your right shoulder and then
grope the entire surface of the left breast with a move like step 3, repeat on the right breast.
6) Stage 6
Pay particular attention to the upper part of the breast (near the armpit) because the area is often
found in the tumor. Check with your doctor immediately if you notice any suspicious changes.

7. Breast examination should be done on:

a. A few days after the menstrual period ends, or choose a memorable date for a routine checkup.
b. For those aged 35 years, routinely do mammography each year.
c. If the family has a history of breast cancer, immediately consult a doctor regularly.
d. Check out any changes that occur in your breasts.

8. Benefits of Breast Self-examination (BSE)

One of the goals of Breast Self-Examination (BSE) is to detect cancer in the early stages, to feel
and to find the beginning of the growing (something that props) in the breast. If BSE is
performed routinely, a woman will be able to find a lump in the early stages. BSE should be
done at the same time every month. For women who still have menstruation the most appropriate
time to do BSE is 7-10 days after the first day of menstruation, for post-menopausal women,
BSE can be done at any time, but routinely done every month (eg every month).