Devices for Home Evaluation of Women's Health Concerns

Kelly L. Scolaro; Kimberly Braxton Lloyd; Kristen L. Helms

Disclosures

Am J Health Syst Pharm. 2008;65(4):299-314. 

In This Article

Aids for Breast Self-examination

The five-year survival rate in women diagnosed with breast cancer is 98% for patients with disease limited to the breast tissue. Progression of cancer to the surrounding tissues decreases the five-year survival rate to 81%, and metastatic disease results in a survival rate of only 26%.[78] Annual mammograms are recommended for all women older than 40 years and have been shown to identify 80–90% of breast cancers.[78,79,80] Between mammograms, and for all women older than 20 years, the American Cancer Society recommends monthly breast self-examination to aid in early detection.[78] Although clinical trials have shown no mortality benefit from self-exams, the practice may allow some patients to detect early stages of cancer.[78]

Two types of devices are available to assist with breast self-exams. The first type is a simulated breast designed to train patients to detect lumps.[81] MammaCare (Mammatech) provides personal kits that meet the specific concerns and needs of the patient. Breast models are available with two skin tones (dark and light), two types of breast firmness (soft and firm), and three depths of simulated nodules (low, medium, and high). Each model contains several lumps ranging in diameter from 3 mm to 1 cm. The kits include a 45-minute instructional tape. Prices range from $55 to $60. Also available are videotapes in multiple languages, instruction in Braille, record books, and professional kits for practitioner training and patient education.[81]

The second type of product is used during the breast exam to optimize nodule palpation. The Aware Self Examination Pad (Biomerica) is a thin polyurethane pad approximately 9.5 in in diameter and containing 25 mL of silicone.[82] The manufacturer states that this pad should be placed over the breast prior to a self-exam to increase the sensitivity of the fingers to abnormalities and to decrease friction between the breast and the fingers. Each kit contains one poly-urethane pad, one instructional videotape, and one resource guide and costs $24.90 from the manufacturer; the usable life of a pad is not identified in the product information. This product is also available in 3-, 6-, and 12-pad kits.

There are no data to suggest that these products increase the detection of breast cancer or decrease mortality.[82] These devices may enhance patient comfort and skill in performing self-exams. In addition, for health care providers with limited time for counseling patients about self-exams, the MammaCare education tool may be helpful in reinforcing what is discussed with the patient in the clinic setting. Much of the information provided to patients is written, so the visual images may prove especially helpful in populations with low literacy rates. These products are primarily intended to increase awareness and to optimize technique in self-exams.

Annual mammograms are recommended for all women greater than 40 years of age, and self-exams should be performed monthly. For self-exams, the patient should be advised as follows:[78,83]

  1. Perform your monthly breast exam while lying down. This allows the breast tissue to spread out over the chest wall for an easier and more thorough exam.

  2. With the pads of the three middle fingers of the hand opposite the breast you are examining, press against the breast tissue and make small circular motions.

  3. Either start from the center of the breast and work outward or make vertical "lines" from one side of the breast to the other. You should also examine the armpits.

  4. Use three levels of pressure in each location to detect lumps at various depths within the breast and armpit tissue.

  5. Repeat this process with your other hand on the opposite side.

  6. Stand in front of the mirror with your hands on your hips and look for any abnormalities or changes in your breasts from their previous appearance.

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