Yes, an obstetrician-gynecologist (OB/GYN) routinely performs a Clinical Breast Examination (CBE) as a standard part of a well-woman checkup. The CBE is a physical examination where the healthcare provider visually and manually assesses the breasts and surrounding areas. This hands-on assessment is a component of comprehensive gynecological care, which often includes discussions about reproductive health, family planning, and preventative screenings. Although screening guidelines for breast cancer are constantly being refined, the physical exam remains a method for a provider to detect changes that may not yet be obvious to the patient.
The OB/GYN’s Scope in Breast Health Screening
The OB/GYN is often the primary healthcare provider for women, which places them in a position to oversee preventative health, including breast health. This specialty is focused on the health of the female patient, naturally linking the assessment of breast tissue with the reproductive system. The annual gynecological visit creates a scheduled opportunity for this screening to occur consistently.
Guidelines from organizations like the American College of Obstetricians and Gynecologists (ACOG) recommend offering a CBE to women between 25 and 39 years old every one to three years. For patients aged 40 and older, the Clinical Breast Examination can be offered annually as part of routine care. These are general recommendations for women at average risk, and individual patient history or risk factors may prompt a different screening schedule.
The Clinical Breast Examination is distinct from other screening methods, such as a self-exam or a mammogram. The provider’s trained touch and visual inspection look for subtle changes that might be missed otherwise, acting as an initial point of detection. While mammography is the primary tool for breast cancer screening, the CBE allows the OB/GYN to establish a baseline for the patient’s breast tissue and address any immediate concerns.
Details of the Clinical Breast Examination
The Clinical Breast Examination begins with a visual inspection of the breast tissue. The patient is typically seated, and the provider looks for any changes in the skin color, texture, or symmetry of the breasts. The provider may ask the patient to raise their arms above their head or press their hands against their hips to contract the pectoral muscles, which helps reveal subtle dimpling or tethering of the skin.
The physical palpation phase is performed while the patient is lying down, a position that helps to flatten the breast tissue against the chest wall for a more thorough feel. The provider uses the pads of their fingers to systematically check all parts of the breast, nipple, and the surrounding areas, including the armpit (axilla) and the area above the collarbone. This palpation uses firm pressure to assess for any lumps, areas of thickening, or unusual tenderness.
When palpating, the provider is noting the size, shape, and consistency of any found masses, as well as whether they are mobile or fixed to the underlying tissue. The examination covers the entire area where breast tissue is present, which extends into the armpit and up toward the collarbone.
Next Steps Following an Abnormal Finding
If the OB/GYN detects an abnormality during the Clinical Breast Examination, such as a palpable mass, skin change, or nipple discharge, the next step is a diagnostic evaluation. Most abnormal findings from a CBE are not cancerous, but they require further investigation to determine the cause. The follow-up tests are chosen based on the nature of the finding and the patient’s age.
For women younger than 30 with a palpable lump, the initial follow-up often involves a breast ultrasound, which can help distinguish between a fluid-filled cyst and a solid mass. For women aged 30 or older, or for suspicious findings, the diagnostic pathway typically includes both a diagnostic mammogram and an ultrasound. A diagnostic mammogram takes more images than a standard screening mammogram to focus on the area of concern.
If imaging tests remain inconclusive or show highly suspicious features, the next procedure is a biopsy, which involves removing a small sample of tissue for laboratory analysis. This sample is typically taken using a core needle under imaging guidance, allowing a definitive diagnosis. If the finding is confirmed to be malignant, the OB/GYN will facilitate a referral to specialized oncologists or breast surgeons to begin treatment planning.