Clinical Breast Examination
No data exist regarding the ideal age at which to begin clinical breast examinations in the asymptomatic, low-risk patient. Expert opinion suggests that the value of clinical breast examination and the ideal time to start such examinations is influenced by the patient’s age and known risk factors for breast cancer. The occurrence of breast cancer is rare before age 20 years and uncommon before age 30 years. Based on available evidence, the College, the American Cancer Society (ACS), and the National Comprehensive Cancer Network recommend that clinical breast examination be performed annually in women aged 40 years and older.
Although the value of a screening clinical breast examination for women with a low prevalence of breast cancer (eg, women aged 20–39 years) is not clear, the College, ACS, and the National Comprehensive Cancer Network continue with these recommendations.
- Clinical breast examination for these women.
- Recommend the teaching of breast self-awareness and inquiry into medical history and family history of risk factors for breast disease. Breast self-awareness educates patients about the normal feel and appearance of their breasts, and include performing breast self-examinations.
Mammography is the primary tool for breast cancer screening, and the roles of the clinical breast examinations and breast self-examinations have been questioned by some experts. The 2009 U.S. Preventive Services Task Force report on breast cancer screening states that “current evidence is insufficient to assess the additional benefits and harms of clinical breast examinations beyond screening mammography in women 40 years and older”. The data evaluated by the U.S. Preventive Services Task Force in its 2009 recommendation suggest that teaching breast self-examination does not reduce the mortality rate of breast cancer and it recommends against clinicians teaching women how to perform breast self-examination. However, 8–17% of cases of breast cancer are missed by mammography.
- The clinical breast examination and breast self-awareness, which includes breast self-examination, have the potential to detect a palpable cancer.
- Some studies show that clinical breast examination and mammography together have a better sensitivity than mammographic screening alone for detecting breast cancer.
- Clinical breast examination still is recommended as part of the periodic health examination of women, especially those with known risk factors for breast cancer.