Screening for Breast Cancer with Clinical Breast Examination

About

Clinical breast examination is a simple and inexpensive method of detecting breast cancer especially in women who do not have access to mammography or in whom mammography may not be feasible.

Breast cancer is one of the most common cancers affecting women worldwide. Statistics from the year 2008 indicate that about 1, 82,000 breast cancer cases with 40, 481 deaths were reported in the US. Though the percentage of breast cancer cases appeared less in India due to its high population, the number of new cases of breast cancer diagnosed in 2008 i.e.1, 15,000, was not far behind. The number of deaths due to breast cancer in India in 2008 was 53, 592.

Early diagnosis of breast cancer through screening techniques could result in complete cure of the patient. The screening methods used for screening of breast cancer are listed below:

• Self Breast Examination
• Clinical Breast Examination
• Film Mammography
• Digital Mammography
• MRI (in high-risk cases)

Clinical breast examination is a procedure where the health care personnel such as doctors or nurses carefully examines the breasts for evidence of any abnormality such as lumps or blood discharge from the nipple. This is in contrast to a breast self examination where the woman exams her breasts on her own at home.

Screening with Clinical Breast Examination

Women in their 20s and 30s should undergo annual or every three yearly clinical breast examinations. Women over 40 years should get it done annually.

Who should undergo clinical breast examination?

The recommendations for clinical breast examination differ among different organizations, ranging from yearly to three yearly examinations for women in their 20s and 30s and yearly examinations thereafter. The US Preventative Services Task Force indicates that a clinical breast examination may not be important for patients undergoing mammography.

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If you are a woman over 20 years of age, you should definitely consider annual to every-three-yearly clinical breast examination, especially if you are at high risk for breast cancer and may not be able to undergo mammography. If you notice any obvious abnormality like a lump or bloody secretion from the nipple, you should get a clinical breast examination done immediately.

How are the breasts examined during a clinical breast examination?

Clinical breast examination is usually performed in a clinic after assuring adequate privacy. The woman has to undress up to the waist for the examination. The health care professional examines the breasts for any obvious abnormal changes in the nipples or skin overlying the breasts. The breasts may also be examined in the sitting position with the arms overhead, at the side and on the hips.

The health care professional then feels the breast with the pads of his/her fingers for any abnormality with the woman in lying down position and her head resting on her hands. The area from the collar bone to the about one inch below the breast is examined. The armpits are also examined for any swellings. (Cancer from the breast can spread to lymph nodes in the armpits, causing them to swell.) The nipples may be checked to detect the presence of secretion.

What are the advantages of clinical breast examination?

Clinical breast examination is a simple and inexpensive way of screening for breast cancer. It does not require any machinery and can be done at any primary care center. A clinical breast examination done before mammography can give the radiologist additional information, thus improving the chances of detecting a cancer on mammography. It could also help to detect other conditions affecting the breast besides cancer like fibroadenoma.

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What are the harms of clinical breast examination?

The procedure of clinical breast examination does not have any side effects. However, like other screening procedures, it could lead to false-positive results i.e. suspicion of breast cancer when it is not present. Patients with the slightest abnormality may be subjected to unnecessary additional tests like imaging and biopsy, thus increasing the cost of treatment and causing additional discomfort to the patient. It could also cause unnecessary anxiety to the patient.

Frequently Asked Questions

1) Which doctor should I visit to get a clinical breast examination done?

You should visit your general physician or gynecologist for a clinical breast examination. If there is any abnormality detected, you may be referred to a general surgeon/cancer surgeon for further workup and treatment.

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2) Which is better - breast self examination or clinical breast examination?

Current evidence does not indicate that breast self examination reduces the number of deaths due to breast cancer. Clinical breast examination has a sensitivity i.e. ability to detect breast cancer of 40% to 69%, whereas the sensitivity for breast self examination ranges from 12% to 41%, which is much lower. Thus clinical breast examination is better, though breast self examination can be done in the comfort of one’s home.

3) Which is the best screening test for breast cancer?

Mammogram done between the ages of 50 and 79 years of age has been shown to reduce deaths caused due to breast cancer. If mammography is done as recommended, clinical breast examinations may not show any additional benefit in diagnosing breast cancer. However, in places like India where mammography is not feasible or widely available, clinical breast examination continues to play an important role in the detection of breast cancer. A complete clinical breast examination with the health care professional spending adequate time in examination helps in screening for breast cancer in these situations. It is also be useful in younger women, in whom mammography may not be of much use.