This page contains a Flash digital edition of a book.

BENIGN BREAST DISEASE Nine out of 10 lumps are benign10

with benign referrals making up

the biggest percentage to a breast unit. Just as breast cancer is common, so are benign conditions (see Box 1). Diagnosis of a benign lump will require the same assessment as for a suspected cancer. This will include a clinical examination, mammography if a woman is over 35 years old, an ultrasound scan and a biopsy for a discrete lesion.

THE ROLE OF THE PRIMARY CARE NURSE The primary care nurse, once empowered with knowledge and skills, can educate and support women in being breast aware by encouraging and teaching health promotion. Evidence exists that education in breast awareness has profound effects on compli- ance11

and the practice nurse is ideally placed as the first point of

contact and can influence the prompt and appropriate referral to a dedicated breast unit. With the support of teaching aids, time and the abundance of written literature available for women, nurses can easily facilitate breast awareness as it is such an important health promoting behaviour. Breast pain in the young woman for example in the absence of a lump could be managed by the primary care nurse. Caffeine, an ill fitting bra, costo-chondritis and hormonal changes are all causes of breast pain.

BREAST AWARENESS Since 1991, ‘breast awareness’ has been the current advocated policy. This involves knowing your breasts and how they look and feel. Breast self-examination is incorporated into breast aware- ness, but breast awareness is not merely the monthly repetitive palpation of the breasts to a rigorous set method. There is also a belief that women and nurses should be properly trained in order to perform BSE.12

This is further supported by the RCN who

recommend specialist training for nurses involved in diagnostic examinations and who issued an educative document for nurses in 2002 entitled Breast palpation and breast awareness.2 Education for breast awareness follows a five-point plan (see

Box 2). The RCN emphasises the role of the nurse in educating and encouraging women to be familiar with their breasts. It advocates written information as well as verbal and stresses the importance of nurses being aware of the management of breast problems.2

Therefore, if a woman notices any of these changes,

she should see the GP or practice nurse and be referred on to a specialised breast unit. This also applies to pregnant women.


Size: if one breast becomes larger or lower. Nipples: if a nipple becomes inverted or changes shape or position. Rashes: on or around the nipple. Discharge: from one or both nipples, especially blood. Skin changes: any puckering or dimpling; appearance similar to the skin of an orange. Swelling: either under the armpit or around the collarbone where lymph glands are. Pain which is continuous in one part of the breast or armpit. A lump or thickening which is different to the rest of the breast. A red swollen painful breast.10

There are referral guidelines available for GPs and nurses in every practice. Leaflets and information on breast awareness, from charities like Breast Cancer Care and Breakthrough Breast Cancer, are also available for women and healthcare profession- als.

EFFECTIVE BREAST SELF-EXAMINATION When examining the breast, women should be advised to perform the examination at the same time each month. If pre-menopausal this should be after menstruation when the breasts are soft. If post-menopausal this should be the same time each examination. It can be performed lying down, standing up or in the shower. The flat parts of the fingers are used using the opposite hand to examine each breast. It is important not to pinch the breast tissue between the fingers as this could feel like a lump.

CONCLUSION This article has discussed the importance of breast awareness for cancer and benign conditions of the breast, how to be breast aware and the role of the primary care nurse in promoting this behaviour. Breast awareness should be incorporated into the activities of

normal everyday living and not be seen as a threatening chore. Empowering the patient to take control over their health and wellbeing is every nurses business and the primary care nurse is vital in this process.

REFERENCES 1. Department of Health. The NHS Cancer Plan: A plan for investment, a plan for reform. London: HMSO; 2000.

2. Royal College of Nursing. Breast Palpation and Breast Awareness; The Role of the Nurse. London: RCN; 2002.

3. Cancer Research UK. Breast Cancer - UK Incidence Statistics. London: CRUK; 2009. Available at: cancerstats/types/breast/incidence

4. Cancer Research UK. Breast Cancer – UK Mortality Statistics. Available at: breast/mortality

5. Mayor S. UK Improves Cancer Control. BMJ. 2003;326:72. 6. Bailey K. The nurses role in promoting breast awareness. Nursing Standard. 2000;14(30):34-6.

7. Banning M. Perceptions of Breast Awareness in Black British Women. Eur J Onc Nursing 2011:15;173-77.

8. NHS breast screening programme. Screening for Breast Cancer in England: Past and Future. London: NHSBSP; 2006. Available at:

9. Kosters JP, Gotzsche PC. Regular Self-examination or Clinical Examination for Early Detection of Breast Cancer. Cochrane Database Syst Rev. 2003;(2):CD003373.

10. Breast Cancer Care. Your Breasts, Your Health Throughout Life. London: Breast Cancer Care; 2009. Available at: breast-care

11. Funke L, Krause-Bergman B, Pabst R, Nave H. Prospective analysis of the long-term effect of teaching breast self-examination and breast awareness. Eur J Cancer Care 2008;17:371-76.

12. Thornton H, Pillarisetti RR. Breast awareness and breast self-exami- nation are not the same. What do these terms mean? Why are they confused? What can we do? Eur J Cancer 2008;2118-21.

13. Department of Health. Be Breast Aware. London: DH; 2006. Available at:

62 Nursing in Practice March/April 2012

Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84