Journal of General Internal Medicine

, Volume 28, Issue 5, pp 719–722 | Cite as

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

Perspectives

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.

KEY WORDS

clinical breast exam women’s health medical education simulation 

REFERENCES

  1. 1.
    Preventive US. Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151(10):716–726.CrossRefGoogle Scholar
  2. 2.
    Barton MB, Elmore JG, Fletcher SW. Breast symptoms among women enrolled in a health maintenance organization: frequency, evaluation, and outcome. Ann Intern Med. 1999;130(8):651–657.PubMedCrossRefGoogle Scholar
  3. 3.
    Haakinson DJ, Stucky CH, Dueck AC, et al. A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J Surg. 2010;200(6):712–717. discussion 717–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Barlow WE, Lehman CD, Zheng Y, et al. Performance of diagnostic mammography for women with signs or symptoms of breast cancer. J Natl Cancer Inst. 2002;94(15):1151–1159.PubMedCrossRefGoogle Scholar
  5. 5.
    Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2012: a review of current American cancer society guidelines and issues in cancer screening. CA Cancer J Clin. 2012;62(2):129–142.CrossRefGoogle Scholar
  6. 6.
    The American College of Obstetricians-Gynecologists. Practice bulletin no. 122: breast cancer screening. Obstet Gynecol. 2011;118:372–382.CrossRefGoogle Scholar
  7. 7.
    Barton MB, Harris R, Fletcher SW. Does this patient have breast cancer? The screening clinical breast examination: should it be done? JAMA. 1999;282(13):1270–1280.PubMedCrossRefGoogle Scholar
  8. 8.
    Bobo JK, Lee NC, Thames SF. Findings from 752,081 clinical breast examinations reported to a national screening program from 1995 through 1998. J Natl Cancer Inst. 2000;92(12):971–976.PubMedCrossRefGoogle Scholar
  9. 9.
    Miller AB, To T, Baines CJ, Wall C. Canadian National Breast Screening Study-2: 13-year results of a randomized trial in women aged 50–59 years. J Natl Cancer Inst. 2000;92(18):1490–1499.PubMedCrossRefGoogle Scholar
  10. 10.
    Ma I, Dueck A, Gray R, et al. Clinical and self breast examination remain important in the era of modern screening. Ann Surg Oncol. 2012;5:1484–1490.CrossRefGoogle Scholar
  11. 11.
    Weiss NS. Breast cancer mortality in relation to clinical breast examination and breast self-examination. Breast J. 2003;9(Suppl 2):S86–S89.PubMedCrossRefGoogle Scholar
  12. 12.
    Checka CM, Chun JE, Schnabel FR, Lee J, Toth H. The Relationship of Mammographic Density and Age: Implications for Breast Cancer Screening. AJR Am J Roentgenol. 2012; 198(3):W292–5.Google Scholar
  13. 13.
    Corbex M, Burton R, Sancho-Garnier H. Breast cancer early detection methods for low and middle income countries, a review of the evidence. Breast. 2012;21:428–434.PubMedCrossRefGoogle Scholar
  14. 14.
    Okonkwo, Draisma G, Kinderen A, Brown ML, Koning H. Breast cancer screening policies in developing countries. J Natl Cancer Inst. 2008;100(18):1290–1300.PubMedCrossRefGoogle Scholar
  15. 15.
    Sankaranarayanan R, Ramadas K, Thara S, et al. Clinical breast examination: preliminary results from a cluster randomized controlled trial in India. J Natl Cancer Inst. 2011;103(19):1476–1480.PubMedCrossRefGoogle Scholar
  16. 16.
    Chiarelli AM, Majpruz V, Brown P, Thériault M, Shumak R, Mai V. The contribution of clinical breast examination to accuracy of breast screening. J Natl Cancer Inst. 2009;101(18):1236–1243.PubMedCrossRefGoogle Scholar
  17. 17.
    Kalager M, Adami H, Bretthauer M, Tamimi RM. Overdiagnosis of invasive breast cancer due to mammogram screening: results from the Norwegian Screening Program. Ann Intern Med. 2012;156(7):491–499.PubMedCrossRefGoogle Scholar
  18. 18.
    Elmore JG, Barton MB, Moceri VM, Polk S, Arena PJ, Fletcher SW. Ten-year risk of false positive screening mammograms and clinical breast examinations. N Eng J Med. 1998;338(16):1089–1096.CrossRefGoogle Scholar
  19. 19.
    Davey HM, Barratt AL, Davey E, Butow PN, et al. Medical tests: women’s reported and preferred decision-making roles and preferences for information on benefits, side-effects and false results. Health Expect. 2002;5(4):330–340.PubMedCrossRefGoogle Scholar
  20. 20.
    Dunn AS, Shridharani KV, Lou W, Bernstein J, Horowitz CR. Physician-patient discussions of controversial cancer screening tests. Am J Prev Med. 2001;20(2):130–134.PubMedCrossRefGoogle Scholar
  21. 21.
    Kurtz ME, Given B, Given CW, Kurtz JC. Relationships of barriers and facilitators to breast self-examination, mammography, and clinical breast examination in a worksite population. Cancer Nurs. 1993;16(4):251–259.PubMedCrossRefGoogle Scholar
  22. 22.
    Saslow D, Hannon J, Osuch J, et al. Clinical breast examination: practical recommendations for optimizing performance and reporting. CA Cancer J Clin. 2004;54(6):327–344.PubMedCrossRefGoogle Scholar
  23. 23.
    Steiner E, Austin DF, Prouser NC. Detection and description of small breast masses by residents trained using a standardized clinical breast exam curriculum. J Gen Intern Med. 2008;23(2):129–134.PubMedCrossRefGoogle Scholar
  24. 24.
    Pugh CM, Salud LH. Fear of missing a lesion: use of simulated breast models to decrease student anxiety when learning clinical breast examinations. Am J Surg. 2007;193:766–770.PubMedCrossRefGoogle Scholar
  25. 25.
    Schubart JR, Erdahl L, Smith JS, Purichia H, Kauffman GL, Kass RB. Use of breast simulators compared with standardized patients in teaching the clinical breast examination to students. J Surg Educ. 2012;69(3):416–422.PubMedCrossRefGoogle Scholar
  26. 26.
    Kyoto Kagaku Co., LTD. http://www.kyotokagaku.com/products/detail01/m44.html. Accessed January 1, 2013.
  27. 27.
    Gaumard-Simulators for Healthcare Education. http://www.gaumard.com/breast-examination-simulator-s230-42/ Accessed January 1, 2013.
  28. 28.
    MammaCare- Clinical Breast Exam Certification and Breast Self-Exam Teaching. http://www.mammacare.com/index.php. Accessed January 1, 2013.

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  1. 1.General Internal Medicine, University of Alabama at Birmingham School of MedicineBirmingham Veterans Affairs Medical CenterBirminghamUSA

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