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Clinical Breast Exam

Breast cancer is the most common form of cancer in women, after skin cancer, and every woman is at risk. Although breast cancer cannot be prevented, it can often be detected at an early stage. Clinical breast examination (CBE),   a breast exam by a health practitioner, is an important component in the early detection of breast cancer. Trained and experienced health care providers can find breast abnormalities that a woman might not have felt herself, and can detect lumps as small as a pea (about 1 centimeter). The combination of mammograms, clinical breast exams and an awareness of the normal appearance and feel of your own breasts is the best way to find breast cancer early, when it is the most treatable.

The CBE should be part of a woman’s regular gynecological or annual check-up, and can be performed by your family doctor, gynecologist, nurse or physician assistant. Some radiology facilities will have a trained technologist perform a CBE before your mammogram. NABCO recommends that women age 20 and older have a CBE every year. If your health care provider does not perform a CBE, you should make sure to request it.

When you have your CBE, let your provider know if you have noticed anything unusual in your breasts. Every woman should become familiar with how her breasts normally feel, and examine them for any changes over time or to evaluate any current symptoms. If you notice a lump or other change (dimpling of the skin, nipple changes or discharge, pain or other abnormality), have it checked out promptly. Many women, especially younger women, have breast tissue that feels lumpy. This is normal, but it may make noticing new lumps or changes more difficult. The CBE is a good time for you to ask your provider about any breast health concerns you might have. If you are unsure about what is normal for you, ask your provider to show you how to examine your breasts and what the normal landscape of your breasts is.

What to Expect During Your CBE

Before your exam, your health care provider will first take a complete history, including information about your menstrual cycle and its regularity, whether you have been pregnant or had children, your family history of breast cancer, and past or present use of oral contraceptives, hormone replacement therapy and other medications. This information will help your provider during the physical exam to evaluate any lumps, breast pain or other changes. A good clinical breast exam should take at least 3-5 minutes and be performed in different positions – while you are seated, and lying down. Breast tissue extends from the collarbone all the way down to the ribcage and up underneath the arm (the axillary area), and all of this area should be thoroughly examined.

Your health care provider will first observe the way your breasts look – whether there are any differences in size, shape or appearance—while your arms are over your head, with hands on your hips, and while leaning forward and flexing the chest muscles. Many women have breasts that are slightly different in shape and size, and this is normal. Differences in appearance that are new or significant should be investigated to make sure that there is no underlying mass causing the change. The skin of the breast and the nipple should also be carefully inspected. Most slight swelling, redness, rashes or other skin presentations are normal, but if they continue or worsen, should be evaluated to rule out a serious breast abnormality. Any changes in the nipple, such as retraction (your nipple becoming inverted, when it was not previously), should also be investigated.

The second part of the CBE involves palpation (feeling) of the breast and underlying tissue. The pressure should be firm, but not painful. CBE is usually done with one hand, while the other hand holds the breast stable. There are many different palpation techniques, but the important factor is that all breast tissue should be examined. In order to make sure this is accomplished, your health care provider will ask you to raise your arms while seated as well as while lying down. This will flatten out the breast and allow different parts of the underlying breast tissue to be closer to the surface. Large-breasted women may find it necessary to place a folded towel or pillow under their shoulder to elevate the breast and make the tissue as flat as possible. It is also important that the area under the arm be examined carefully to detect any enlargement in the lymph nodes.

Next Steps

If a lump or abnormality is found during your CBE, there are several things you should know. First, the vast majority of suspicious lumps turn out to be benign (not cancer). Your health care provider may request that you return to have the suspicious area rechecked in a month, or you may be advised to have a diagnostic mammogram, breast ultrasound (sonogram), or a consultation with a breast surgeon to re-evaluate the physical findings. It is important to be aware that sometimes a mammogram, and even an ultrasound, may not show a mass that can be felt, therefore any questionable findings from a CBE should be thoroughly investigated even when a mammogram or ultrasound are inconclusive. In such cases, a breast specialist should be consulted for further evaluation of the clinical findings and to consider the options, including biopsy.