The Clinical Breast Exam: A Skill that Should Not Be Abandoned

Abstract

The clinical breast exam (CBE) is an important tool in the care of women. However, the utility of the screening CBE has been called into question. This article discusses the importance of the CBE as a physical diagnosis tool. Recommendations regarding screening with CBE are reviewed, and evidence surrounding breast cancer screening using CBE is briefly summarized. Clinicians should strive to provide high quality CBEs as part of the general clinical exam for women, particularly those who present with breast complaints, and for patients who choose to have CBE screening. In conclusion, there is a role for the CBE in the care of women, and clinicians should be proficient at performing these exams. Simulation teaching technologies are now available at Department of Veteran Affairs (VA) facilities to enable clinicians to improve their CBE skills. T he clinical breast exam (CBE) is an important tool in the care of women. It is utilized for the evaluation of breast complaints and, more controversially, in breast cancer screening. The Department of Veteran Affairs (VA) Women's Health Services Office has recently coordinated the distribution of breast exam simulation equipment to VA facilities in order to enhance CBE competency training for VA providers. Since the utility of the screening CBE has been called into question, 1 the issue may be raised as to whether this training is pertinent. The following summary will provide rationale that the CBE is an important physical diagnosis skill that should not be discarded, and that simulation equipment is a helpful tool in training clinicians.Clearly, the CBE is required for the evaluation of patients with breast complaints, particularly those with a breast lump. In one study of primary care clinics, 11 % of women complaining of a breast lump and 4 % of women with any breast complaint were found to have a malignancy. 2 In addition, a significant number of patients with breast cancer present with a palpable breast mass. Haakinson et al. 3 reported that 34 % of women with invasive breast cancer initially presented with a palpable lesion. 13 % of the women with a palpable breast mass who were found to have invasive cancer had a normal mammogram within the previous year. Likewise, a large study of diagnostic mammograms reported that the sensitivity of mammography in women with a self-reported breast lump was 87.3 %. 4 This suggests that approximately 13 % of clinically evident breast cancers may be missed by mammography imaging. Therefore, identifying these tumors by palpation is a pertinent clinical issue, and providers should be proficient at discerning abnormal breast findings.The more divisive issue is whether the clinical breast exam should be used in conjunction with mammography for breast cancer screening in asymptomatic patients. The US Preventive Services Task Force (USPSTF) states that there is insufficient evidence to recommend for or against routine screening with the CBE. 1 However, the American Cancer Society 5 and the American College of Obstetricians and Gynecologist...

Is Clinical Breast Examination Important for Breast Cancer Detection?

“…However, a physician who does not perform cbe regularly will have more difficulty in executing the technique correctly and will need more examinations and imaging, increasing costs and perhaps postponing a diagnosis by not ordering tests for those women. Although the present study was not designed to determine if cbe could be added as a screening tool for the general population, our results suggest that cbe should be performed for women with symptoms and should be part of the opportunistic screening in women without symptoms but taking hormone replacement therapy; in women at higher risk, such as young women with dense breasts, familial history, mutation, history of atypical breast lesion, and history of breast cancer 42 ; and possibly also in older women who are less likely to undergo mammographic screening compared with younger women, given that a strong association between older age and delayed diagnosis has been observed 43 . Nevertheless, screening cbe could be proposed to women who refuse to participate in mammographic breast cancer screening programs.…”

“…Nevertheless, screening cbe could be proposed to women who refuse to participate in mammographic breast cancer screening programs. We must raise the issue that physicians in training are no longer systematically trained in performing cbe despite the availability of new training technologies that emulate diseased breasts 42 . In light of the present study and based on recent recommendations against cbe [12][13][14]16,17 , some breast cancers will probably be found at late stages in the future.…”

The prevalence of practicing breast self-examination and knowledge of breast cancer disease among women attending secondary health facility

“…There remains a role for the CBE in the care of women who present with breast complaints. 12 In contrary to mammography and CBE, which require specialized equipment, expertise and hospital visits, BSE is inexpensive and is carried out by women themselves to detect any changes or abnormalities in the breast. Although, there are still conflict of opinions about the efficacy and effectiveness of BSE as a screening tool.…”

Do Primary Care Physician Perform Clinical Breast Exams Prior to Ordering a Mammogram?

“…A retrospective review found that 13-17% of women with newly diagnosed breast cancer present with a palpable lump within 1 year of a normal SM (4), further illustrating the important role of CBE in breast cancer surveillance. Prior studies have demonstrated the importance of developing CBE skills, with the advent of simulations and clinical practice the keys to becoming proficient at this examination (5,6).…”