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Breast Examination

  • Author: Sara J Grethlein, MD; Chief Editor: Christine Isaacs, MD  more...
 
Updated: Jan 22, 2016
 

Background

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.

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Indications

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.[1]

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Contraindications

Because evidence of benefit is lacking, if a woman is excessively anxious about the breast examination, it can be foregone.

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Best Practices

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.

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Complication Prevention

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.[4]

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Contributor Information and Disclosures
Author

Sara J Grethlein, MD Associate Dean for Undergraduate Medical Education, Indiana University School of Medicine

Sara J Grethlein, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Hematology, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Chief Editor

Christine Isaacs, MD Associate Professor, Department of Obstetrics and Gynecology, Division Head, General Obstetrics and Gynecology, Medical Director of Midwifery Services, Virginia Commonwealth University School of Medicine

Christine Isaacs, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.

References
  1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm.

  2. Kosters JP, Gotzsche PC. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev. 2003. CD003373. [Medline].

  3. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-detection.

  4. Baines CJ, Miller AB, Bassett AA. Physical examination. Its role as a single screening modality in the Canadian National Breast Screening Study. Cancer. 1989 May 1. 63(9):1816-22. [Medline].

  5. Coleman EA, Heard JK. Clinical breast examination: an illustrated educational review and update. Clin Excell Nurse Pract. 2001 Jul. 5(4):197-204. [Medline].

  6. Coates Moorman, Henry Pennypacker, Peggy Pierce, Eva Sciandra, Robert Smith and Ralph Kopans, Susan Kutner, et al. Lane, Herschel Lawson, Helen Meissner, Candace Mary Barton, Janet Kay Bobo, Cathy Coleman, Mary Dolan, Ginny Gaumer, Daniel Debbie Saslow, Judy Hannan, Janet Osuch, Marianne H. Alciati, Cornelia Baines, Clinical Breast Examination: Practical Recommendations for Optimizing Performance and Reporting,. CA Cancer J Clin. 2004. 54:327-344.

  7. Lord SJ, Lei W, Craft P, et al. A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer. Eur J Cancer. 2007. 43 (13):190, 20015-17.

 
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