- Author: Sara J Grethlein, MD; Chief Editor: Christine Isaacs, MD more...
The role of radiographic screening for breast cancer (mammography) in women younger than 50 years is controversial. Physical examination of the breasts is both an important adjunct to mammography and a significant screening tool in its own right.
Barriers to accurate and thorough examination include provider or patient discomfort, fear of misinterpretation of attention to the patient’s breasts, and lack of knowledge or skill with the technique.
Although evidence of benefit is insufficient to recommend clinical breast examination (CBE), it is typically incorporated into annual physical examinations.
The American Cancer Society recommends clinical breast examination every 3 years in women aged 20-39 years.
The American College of Obstetricians and Gynecologists (ACOG) recommends that women aged 40 years or older undergo annual clinical breast examination and those aged 20-39 years undergo clinical breast examination every 1-3 years.
The United States Preventive Services Task Force (USPSTF) concluded that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women aged 40 years or older.
Because evidence of benefit is lacking, if a woman is excessively anxious about the breast examination, it can be foregone.
Because of the sensitive nature of the breast examination, many providers choose to have a chaperone present during the examination. There are pros and cons to this approach, and a generally accepted policy is to have clinical staff who can act as chaperones available, to ensure that patients are aware that they are available, and to provide patients with an opportunity for private conversation without the chaperone present.
The harms of undergoing clinical breast examination include the risks of false reassurance or referral for unnecessary procedures.
In the Canadian National Breast Cancer Screening Study, a high percentage of women who were diagnosed with breast cancer had undergone a screening clinical breast examination with negative findings.
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