The Clinical Breast Exam (CBE) is a physical examination of the breasts performed by a trained healthcare professional, such as a doctor, nurse practitioner, or physician assistant. This procedure is a fundamental part of breast health monitoring, acting as a systematic check for any changes or abnormalities in the breast tissue. The purpose is to detect signs of potential issues that may be too small or subtle to be noticed by the patient, aiding in the early detection of various breast conditions.
What Happens During the Clinical Breast Exam
The Clinical Breast Exam is a two-part process that begins with a thorough visual inspection. While the patient is seated, the provider observes the breasts for symmetry, shape, and size. They also check the skin for discoloration, rashes, or texture changes, such as dimpling or puckering that resembles an orange peel (peau d’orange). The provider may ask the patient to raise their arms or press their hands onto their hips to contract the chest muscles, revealing subtle contour changes.
The second part involves palpation, where the provider uses the pads of their fingers to feel the breast tissue for lumps, thickening, or tenderness. For this, the patient typically lies down with the arm on the side being examined placed above or behind the head; this position helps to spread the breast tissue evenly over the chest wall. The examination extends beyond the central breast area, meticulously covering the entire region from the collarbone down to the inframammary fold and laterally into the armpit (axilla).
The professional uses light, medium, and deep pressure at various points to assess the tissue just under the skin, the mid-level tissue, and the tissue closest to the chest wall, respectively. This systematic technique ensures the entire area is covered and allows for differentiation between various types of masses or general tissue firmness. The lymph nodes in the armpit and above the collarbone are also palpated, as they are a common area for potential spread.
Clinical Breast Exam Versus Other Screening Tools
The Clinical Breast Exam occupies a distinct role compared to other common tools used for breast health. Unlike the Breast Self-Exam (BSE), which is performed by the individual, the CBE is conducted by a trained professional using an established, systematic technique. This professional training increases the likelihood of detecting abnormalities that might be missed by an untrained person.
The CBE is also fundamentally different from mammography, which is an imaging test using low-dose X-rays to create pictures of the internal breast structure. A mammogram can detect masses and microcalcifications too small to be felt during a physical exam, making it the gold standard for breast cancer screening. While the physical exam involves feeling and seeing the tissue, mammography provides a view of the tissue density and internal structures.
Most health organizations recommend that these tools be used in a complementary way. For example, some guidelines recommend a CBE every one to three years for women in their 20s and 30s, and annually starting at age 40, often in conjunction with a yearly mammogram. However, some major organizations have stated that there is no clear evidence that routine CBEs or BSEs provide an added benefit for average-risk women who are also getting regular screening mammograms.
Understanding Results and Follow-Up Care
Following a Clinical Breast Exam, the results are generally categorized as either normal or abnormal. A normal result means the provider found no suspicious lumps, unusual skin changes, or enlarged lymph nodes. In this case, the patient will continue with their recommended regular screening schedule.
If the provider identifies an abnormality, this is considered an abnormal or positive finding, necessitating follow-up testing. Most abnormal findings, such as an area of thickening or a palpable lump, are eventually determined to be benign (non-cancerous), such as a cyst or fibroadenoma. A finding that requires follow-up is sometimes referred to as a “false positive” result, which is a necessary part of the diagnostic process despite potentially causing anxiety.
The next step is typically a referral for diagnostic imaging, which may include a diagnostic mammogram, a breast ultrasound, or a magnetic resonance imaging (MRI) scan. These imaging tests provide a more detailed look at the area of concern. If the imaging still shows a suspicious mass, a biopsy, which involves taking a small tissue sample for lab analysis, may be recommended to definitively determine the nature of the finding.