My PEP TALK today is

entitled:
Empowerment BREAST SELF-
objective - for EXAM: A MUST-
laypeople to have an DO FOR ALL
BREAST SELF-
essential FILIPINA
EXAM: A
understanding of
MUST-DO FOR
BREAST SELF-EXAM
ALL FILIPINA
AS A MUST-DO IN
ALL FILIPINA in their
health management.
 Contents Disclaimer:
BREAST SELF- • What is a BREAST SELF-EXAM (BSE)?
EXAM: A • Why is BSE a must-do for all Filipina? ROJoson PEP Talk
• Why is screening mammogram NOT a must-do contains ROJoson’s
MUST-DO FOR
for all Filipina? Thoughts,
ALL FILIPINA • How to do BSE? Perceptions,
• How to interpret the findings in BSE? Opinions and
• What is ROJoson’s advocacy program on BSE? Recommendations
(TPORs) culled from
experiences of other
professionals and
ROJoson.
 What is a BREAST SELF-EXAM (BSE)?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
 What is a BREAST SELF-EXAM (BSE)?
BREAST SELF-
EXAM: A BSE is examination of one’s own breasts,
usually through
MUST-DO FOR
ALL FILIPINA inspection (looking at one’s own breasts) and
palpation (touching and feeling with fingers one’s
own breasts)

for
anything unusual
any abnormality, any disease.
 Why is BSE a must-do for all Filipina?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
 Why is BSE a must-do for all Filipina?
BREAST SELF-
EXAM: A Breast self-exam (BSE) is a must for all Filipina
who love themselves and their bodies and who
MUST-DO FOR
are concerned with their breast well-being.
ALL FILIPINA
(Note: Not wellness as wellness is focused on
physical health but well-being which encompass
wellness and include physical, emotional and
psychological health.)
 Why is BSE a must-do for all Filipina?
BREAST SELF-
EXAM: A Also, BSE is a must because the most dreaded
MUST-DO FOR disease of the breast or breast cancer can strike
anytime and at any age to all Filipina, young and
ALL FILIPINA
old, as long as they are still alive and until they
die of other diseases.
 Why is BSE a must-do for all Filipina?
BREAST SELF-
EXAM: A Also, BSE is a must because breast cancer is the
MUST-DO FOR most common cancer in the Philippines among
the Filipino women (Filipina).
ALL FILIPINA
 Why is BSE a must-do for all Filipina?
BREAST SELF-
EXAM: A Also, BSE is a must as no Filipina should rely
MUST-DO FOR solely or only on a physician or a breast specialist
in their goal to achieve breast well-being.
ALL FILIPINA

Also, BSE is a must as no Filipina should rely

solely on laboratory tests such as mammography
and ultrasound, even if done yearly or every 2
years, in their goal to achieve breast well-being.
 Why is BSE a must-do for all Filipina?
BREAST SELF-
EXAM: A Lastly, BSE is a must because it is simple to do; it costs nothing; and it is
MUST-DO FOR the primary and foremost early breast cancer detection tool.
ALL FILIPINA The physician’s clinical examination of the breast and breast laboratory
tests such as mammography and ultrasound are secondary and should
be preceded by a BSE.
At present, majority of breast cancers among the Filipina are discovered
through BSE and not with physician’s clinical examination of the breast
and breast laboratory tests.
 Why is BSE a must-do for all Filipina?
BREAST SELF-
EXAM: A Thus,
MUST-DO FOR
ALL FILIPINA BSE is a must-do for all
Filipina.
 Why is BSE a must-do for all Filipina?
BREAST SELF-
EXAM: A All Filipina should do BSE starting at the age when they can
MUST-DO FOR be taught how to do BSE and how to interpret findings on
BSE.
ALL FILIPINA
This age can start at the adolescence or teenage period.
Adolescence is the phase of life between childhood and
adulthood, usually from ages 10 to 18. This is the period in
which it is considered an important time for laying the
foundations of good health.
BSE should be done until the end- or near-end of life as
breast cancer can occur up to the oldest age.
 Why is BSE a must-do for all Filipina?
BREAST SELF-
EXAM: A All Filipina should not just rely on physician’s clinical
MUST-DO FOR examination of the breast and breast laboratory tests such
as mammography and ultrasound.
ALL FILIPINA

This practice cannot be sustained because of the

inconvenience and cost involved which will just result to
an IRREGULAR AND HAPHAZARD program for promoting
breast well-being.
 Why is screening mammogram NOT a must-do for
BREAST SELF- all Filipina?
EXAM: A
MUST-DO FOR
ALL FILIPINA
 Screening
Why is screening mammogram NOT a must-do for
mammogram can be
BREAST SELF- all Filipina?
done in Filipina with
EXAM: A high-rsk for breast
Lately (August 2023), it has been reported in
MUST-DO FOR cancer (strong family
JAMA that:
ALL FILIPINA history of breast
cancer).
Current evidence does NOT substantiate the claim
that common cancer screening tests save lives by
SELECTIVE ONLY!
extending lifetime.
NOT ALL! NOT
ROUTINE!
This includes mammography.

https://jamanetwork.com/journals/jamainternalmedicine/ Mammography does

article-abstract/2808648 not replace BSE!
 Why is screening mammogram NOT a must-do for all
BREAST SELF- Filipina?
EXAM: A
Mammography is associated with a lot of uncommitted
MUST-DO FOR
readings (BIRADS – 0); false-positive readings; at times,
ALL FILIPINA false-negative readings.

A lot of times, these have led to undue anxiety for the

patients; unnecessary added procedures; and more
expense.

Thus, screening mammogram is NOT a must-do for all

Filipina.
 How to do BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
 How to do BSE?
BREAST SELF-
EXAM: A To be effective in achieving its goal of promoting
breast well-being and detecting breast cancer
MUST-DO FOR
early enough if it develops, BSE must be done
ALL FILIPINA correctly and regularly, at least once a month.

The essential objective of BSE is to look for

anything unusual. If anything unusual is found,
an attempt at interpretation can be done. A
breast specialist is consulted early as warranted.

NOTE: it takes only a few minutes to do BSE.

 How to do BSE?
BREAST SELF-
EXAM: A When to do BSE?
MUST-DO FOR
For menstruating women, BSE is recommended to be done 7 to 10 days
ALL FILIPINA after the last day of mense. (to avoid hormonal swelling of breast
tissues during mense being mistaken for a dominant mass AND to avoid
the discomfort induced by palpating a breast that is usually sensitive
during time of menstruation)

For non-menstruating women, first or last day of the month is chosen.

It can be done during bath time or any other time.

 How to do BSE?
It takes only a few
BREAST SELF-
Where to do BSE? minutes to do BSE.
EXAM: A
MUST-DO FOR
BSE can be done in any private place such as in a
ALL FILIPINA bathroom during bath time.

Standing up or lying down?

It can be done either standing up or lying down.

 How to do BSE?
BREAST SELF- Visual Inspection (LOOKING)
EXAM: A Expose the upper body.
MUST-DO FOR In a standing position, face a mirror to view entire
ALL FILIPINA chest and breasts.
 How to do BSE?
BREAST SELF- With both arms down and then raised over the
EXAM: A head,
MUST-DO FOR look for anything unusual on the breasts!
ALL FILIPINA
 How to do BSE?
BREAST SELF- Look for changes in the contour of the breasts and
EXAM: A armpits, such as bulge, skin dimpling, and
MUST-DO FOR flattening!
ALL FILIPINA
 How to do BSE?
BREAST SELF- Look for unusual changes on the skin of the
EXAM: A breasts, such as redness and lesions!
MUST-DO FOR
ALL FILIPINA
 How to do BSE?
BREAST SELF- Manual Palpation (FEELING)
EXAM: A In a standing position, with one arm raised over
MUST-DO FOR the head, using the flats of 2 to 3 fingers (2nd to
ALL FILIPINA 4th fingers) of the other hand, gently but firmly
palpate the entire breast on the side where the
arm is raised.
 How to do BSE?
BREAST SELF- Feel for anything unusual in the breast and feel
EXAM: A for a possible presence of a dominant mass!
MUST-DO FOR A dominant mass is an unusual density distinct
ALL FILIPINA from the surrounding breast tissue with a felt
margin or border which connotes a three
dimensional lump.
 How to do BSE?
BREAST SELF- Cover the entire area of the breast by going one
EXAM: A quadrant at a time until all four quadrants of the
MUST-DO FOR breast are palpated.
ALL FILIPINA
 How to do BSE?
BREAST SELF- Before palpating the armpit, gently squeeze the
EXAM: A nipple for possible presence of discharge.
MUST-DO FOR
ALL FILIPINA
 How to do BSE?
BREAST SELF- When palpating the armpit, put the arm down to
EXAM: A have a lax or slack skin fold. Place the palpating
MUST-DO FOR fingers initially at the uppermost portion of the
ALL FILIPINA armpit. Then, gently but firmly press against the
chest wall in the armpit and slowly glide the
fingers downward to feel for anything unusual
and to feel for a possible presence of a dominant
mass!
 How to do BSE?
BREAST SELF- Repeat the same procedures for the other breast,
EXAM: A nipple, and armpit.
MUST-DO FOR
ALL FILIPINA
 How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
 How to interpret the findings in BSE?
BREAST SELF- Take note of the difference between lumpy breast
EXAM: A surface and dominant mass (the real mass – a red
MUST-DO FOR flag if present).
ALL FILIPINA
 How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR - NO dominant breast mass found on physical
examination in persons complaining of breast
ALL FILIPINA mass and in persons coming for breast check =
normal or fibrocystic changes
- Breast pain with NO dominant breast mass =
fibrocystic changes
 How to interpret the findings in BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR - Nonsanguinous (not red) nipple discharge with
ALL FILIPINA NO dominant breast mass = fibrocystic
changes

- Sanguinous (red) nipple discharge with NO

dominant breast mass = intraductal
papilloma
 How to interpret the findings in BSE?
BREAST SELF-
- Focal erythema or redness and tenderness with
EXAM: A
NO dominant breast mass = mastitis
MUST-DO FOR
ALL FILIPINA
 How to interpret the findings in BSE?
BREAST SELF- - Focal erythema or redness with a tender,
EXAM: A
fluctuant dominant breast mass = breast
MUST-DO FOR
ALL FILIPINA
abscess
 How to interpret the findings in BSE?
BREAST SELF-
- cystic mass with no signs of malignancy –
EXAM: A
Macrocyst
MUST-DO FOR
ALL FILIPINA
Cystic means containing fluid.
A cystic mass is one that is depressible.
 How to interpret the findings in BSE?
BREAST SELF- SUSPECT CANCER:
EXAM: A
MUST-DO FOR - Presence of a dominant breast mass with telltale
ALL FILIPINA (or giveaway) signs of malignancy (signs of local
invasion of the breast mass on the adjacent
tissues and signs of spread)

- Presence of sanguinous nipple discharge with an

accompanying dominant mass
 How to interpret the findings in BSE?
BREAST SELF-
EXAM: A CANCER SUSPECT
MUST-DO FOR Signs of local invasion of the breast mass
ALL FILIPINA on the adjacent tissues
• Fixation to the adjacent tissues such as the
overlying skin inclusive of the nipple and
areola and the underlying tissues such as chest
muscles and ribs.
• Skin changes over the mass that are suggestive
and indicative of local invasion such as
ulcerations and fungation.
 How to interpret the findings in BSE?
BREAST SELF- CANCER SUSPECT
EXAM: A Signs of spread
MUST-DO FOR • presence of palpable ipsilateral axillary
ALL FILIPINA lymph node and supraclavicular lymph
node.
 What is ROJoson’s advocacy program on BSE?
BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
 io
What is ROJoson’s advocacy program on BSE?
BREAST SELF-
EXAM: A Dr. ROJoson’s advocacy program on BSE dated as
far back as 1982, a year after he graduated from
MUST-DO FOR
his general surgery residency program from the
ALL FILIPINA Philippine General Hospital and started managing
patients with breast concerns.

He believes BSE is the MOST PRACTICAL way and

very USEFUL and ECONOMICAL at that, to detect
breast cancers among Filipina (breast cancers
being very common among the Filipina).
 What is ROJoson’s advocacy program on BSE?
BREAST SELF- With his more than 40 years of experiences in the management of Filipina
EXAM: A with breast concerns, he does NOT subscribe to using routine (regular)
MUST-DO FOR mammogram nor ultrasound of the breasts as a screening tool for breast
ALL FILIPINA cancers.

Main reasons: He has seen

• A lot of inconclusive reports on mammograms (BIRADS 0)
• A lot of false-positive reports on ultrasounds of the breasts
• False-negative reports

Secondary reason: Most patients cannot sustain a practice of regular

mammogram and ultrasound because of inconvenience and cost.
 What is ROJoson’s advocacy program on BSE?
BREAST SELF- Lately (2023), ROJoson’s stance on routine screening with mammogram
EXAM: A has been validated –
MUST-DO FOR
ALL FILIPINA Ukraine’s adoption of early diagnosis program over screening
mammogram with the blessing of WHO

“Better than screening: with WHO’s help Ukraine chose a cost-efficient

policy to prevent breast cancer” WHO publication
https://www.who.int/europe/news/item/08-03-2021-better-than-
screening-with-who-s-help-ukraine-chose-a-cost-efficient-policy-to-
prevent-breast-cancer
 What is ROJoson’s advocacy program on BSE?
BREAST SELF- Lately (2023), ROJoson’s stance on routine screening with mammogram
EXAM: A has been validated –
MUST-DO FOR
ALL FILIPINA A 2023 paper published in JAMA –
Estimated Lifetime Gained With Cancer Screening Tests

Current evidence does not substantiate the claim that common cancer
screening tests save lives by extending lifetime. This includes
mammography.

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2
808648
 What is ROJoson’s advocacy program on BSE?
BREAST SELF- In 2022, ROJoson created a program called BSE Awards in which he would
EXAM: A give cash awards as incentives to FILIPINA who would do regular BSE for
MUST-DO FOR at least 9 months.
ALL FILIPINA
The primary objective of the Club is to promote early detection of breast
cancers among Filipino women.

Awards were given to 65 BSE promoters and practitioners (a total of P38,

700.00) in December 2022.

The Awards is ongoing in 2023.

BREAST SELF-
EXAM: A
MUST-DO FOR
ALL FILIPINA
 What is ROJoson’s advocacy program on BSE?
BREAST SELF-
EXAM: A Plans for 2024 (will initiate this before the end of
MUST-DO FOR 2023):
ALL FILIPINA Entice / invite Filipina to learn how to do BSE and
how to interpret findings and then take an Online
Learning Cum Evaluation Test Exercise (OLETE).

OLETE passers will get Certificates of

Commitment and Accomplishment, Certificates of
Proficiency and Certificates of Mastery.
 What is ROJoson’s advocacy program on BSE?
BREAST SELF-
EXAM: A Plans for 2024 (will initiate this before the end of
MUST-DO FOR 2023):
ALL FILIPINA Entice / invite Filipina to learn how to do BSE and
how to interpret findings and then take an Online
Learning Cum Evaluation Test Exercise (OLETE).

OLETE passers will get Certificates of

Commitment and Accomplishment, Certificates of
Proficiency and Certificates of Mastery.
 What is ROJoson’s advocacy program on BSE?
BREAST SELF-
EXAM: A Plans for 2024 (will initiate this before the end of
MUST-DO FOR 2023):
ALL FILIPINA Entice / invite Filipina to learn how to do BSE and
how to interpret findings and then take an Online
Learning Cum Evaluation Test Exercise (OLETE).

OLETE passers will get Certificates of

Commitment and Accomplishment, Certificates of
Proficiency and Certificates of Mastery.
 What is ROJoson’s advocacy program on BSE?
BREAST SELF-
EXAM: A Plans for 2024 (will initiate this before the end of
MUST-DO FOR 2023):
ALL FILIPINA Entice / invite Filipina to learn how to do BSE and
how to interpret findings and then take an Online
Learning Cum Evaluation Test Exercise (OLETE).

OLETE passers will get Certificates of

Commitment and Accomplishment, Certificates of
Proficiency and Certificates of Mastery.
 Contents
Summary
BREAST SELF- • What is a BREAST SELF-EXAM (BSE)?
• Why is BSE a must-do for all Filipina? Take Away
EXAM: A
• Why is screening mammogram NOT a must-do
MUST-DO FOR
for all Filipina?
ALL FILIPINA • How to do BSE?
• How to interpret the findings in BSE?
• What is ROJoson’s advocacy program on BSE?
 BSE: A MUST-DO FOR ALL FILIPINA Summary
BREAST SELF- Take Away
EXAM: A • BSE as a health habit is simple and without
cost. It can be repeated anytime without
MUST-DO FOR
added cost. It can be done anytime and
ALL FILIPINA
anywhere.
 BSE: A MUST-DO FOR ALL FILIPINA Summary
BREAST SELF- Take Away
EXAM: A • It can detect breast cancer and other breast
diseases. It can detect early breast cancer as
MUST-DO FOR
long it is done regularly and properly and as
ALL FILIPINA
long as it is reported to a breast specialist early
enough. Consult a breast specialist right away
once a dominant mass is detected during BSE.
 Be always in touch with reliable medical Take Away in
BREAST SELF- information on BREAST SELF-EXAM. relation to
EXAM: A Patient
MUST-DO FOR Knowledge is power; it gives power. Empowerment
ALL FILIPINA Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions /
make better decisions on BREAST SELF-
EXAM AS A MUST-DO FOR ALL FILIPINA in
your health management.
 Empowerment
objective - for
laypeople to have an
BREAST SELF-
essential
EXAM: A
understanding of
MUST-DO FOR
BREAST SELF-EXAM
ALL FILIPINA
AS A MUST-DO IN
ALL FILIPINA in their
health management.