Clinical Breast Exam – Another Tool For Early Detection

Since the release of updated breast cancer screening guidelines from the U.S. Preventive Services Task Force (USPSTF) in November 2009, there has been controversy about which recommendations for clinical breast exam, breast self-exam and film mammography should indeed be followed by women and their health care providers.

Among other aspects of the guidelines, the USPSTF states that there isn't enough strong evidence to conclude that there are added benefits of performing clinical breast exams in women over age 40. However, other organizations disagree.

A clinical breast exam (CBE) helps you and your doctor keep an eye on your breast health. During an appointment for a clinical breast exam, your doctor or nurse will discuss your breast health, check out any changes, and perform a manual and visual exam of your breasts. Many physicians still believe a clinical breast exam does not replace your mammogram or monthly breast self-exam, but is an additional way to check your breasts for cancer or benign breast conditions.

Again, the USPSTF says that there is not enough evidence to recommend for or against routine CBEs alone to detect breast cancer.

The American Cancer Society (ACS) differs in this opinion, recommending that women 20 to 39 get a CBE once every three years during their annual well-woman visit (although your doctor will likely do one at every yearly check-up). Women 40 and older are recommended to get a CBE annually.

The American College of Obstetricians and Gynecologists (ACOG) recommends that women 19 and older get a CBE annually.

This can all be very confusing. The bottom line is that you should do what you and your physician are comfortable with. If you notice a change in your nipples or find a breast lump, you should schedule a clinical breast exam for a professional opinion and get help. Some kinds of breast changes can’t be felt by you or your doctor, so be sure to follow up with a mammogram.

During your clinical breast exam appointment, you can learn how to do a breast self-exam. Be sure to mention any changes you have found in your nipples or breast, such as breast pain or nipple discharge. Some physicians prefer to do a clinical breast exam before they refer you for a screening mammogram. If some change is found, the doctor can provide special instructions for the radiologist. Sometimes a diagnostic image may be taken or an ultrasound done after your mammogram, to get a better view of the area of concern. A CBE can make your mammogram appointment more efficient.

If you need a clinical breast exam, your obstetrician/gynecologist, family doctor, nurse practitioner, or assistant nurse can do it for you. If you are seeing an oncologist, the doctor or nurse can perform your clinical breast exam whenever it is needed. There are some standards for clinical breast exams, but some health professionals have their own variations on the exam procedure. A clinical breast exam is not intended to cause pain, discomfort or embarrassment. Tell your doctor if you have concerns about any of these things.

Your doctor or nurse will do your clinical breast exam in the privacy of an exam room. You will undress from the waist up and put on a gown.

The doctor may take time to ask you about your breast health concerns, especially any changes you may be concerned about. Be sure to tell your doctor if you have breast pain (especially if only on one side), may be pregnant or breastfeeding, have had any breast biopsies or surgery, or have a family history of breast or ovarian cancer.

The first part of your clinical breast exam is visual, just like your breast self-exam. Your doctor will look for symmetry, skin condition, and nipple position. Any abnormalities or changes from your previous exam will be noted. If you have changes in size, shape, color, or texture, or if you have nipple discharge, these changes will be written on your chart. While you are sitting up, you will be asked to move your arms overhead, to the side, and to put your hands on your hips.

Your doctor will do a manual examination of your breasts. You will be asked to recline with your arms back over your head while your breasts are being examined. Your doctor will use finger-pad pressure to feel all areas of your breast tissue. Any lumps or shape changes will get special attention. Where lumps are located, as well as how they respond to pressure and move within breast tissue, will be recorded. Your lymph nodes in your armpits, over your collarbone, and in your neck will also be examined to see if they are swollen or normal. The doctor will check your nipple for discharge and changes in position.

CBE Points to Remember
Your clinical breast exam and mammogram can help you detect breast cancer at an early stage. Smaller cancers (less than 2cm) usually respond to treatment better than larger ones, and they are associated with longer survival rates.

Practice your monthly breast self-exam so you will be well acquainted with cyclical changes in your breasts, and have your clinical breast exam and mammogram on time.

_Sources:

_{Can Breast Cancer Be Found Early? American Cancer Society. Last Revised: 09/18/2009}

_{Understanding Breast Changes: A Health Guide for Women. Check With Your Health Care Provider About Breast Changes. National Cancer Institute. Posted: 09/28/2009.}

_{Clinical Breast Examination: Practical Recommendations for Optimizing Performance and Reporting. Debbie Saslow, PhD, Judy Hannan, RN, MPH, Janet Osuch, MD, MS, et al. CA Cancer J Clin 2004; 54:327-344.}