Dr Cathy Donald explains what a clinical breast examination is.
What is a clinical breast examination?
A clinical breast examination (CBE) is a physical examination of a patient’s breasts and surrounding tissue, which is done by a healthcare provider. It is part of a spectrum of examinations which can be done to diagnose breast pathology.
I have highlighted a few phrases that I would like to discuss further.
>> Healthcare provider
The clinical breast examination is done by the healthcare provider in contrast to self-examination which is the same examination done by yourself. Both these examinations are important.
>> Part of
As already alluded to above, CBE is only one of various examinations used to diagnose breast conditions. Others are self-examination, mammography, ultrasound and, in specific cases, biopsy. Each one has their place. They are used systematically and in conjunction with each other.
>> Breast pathology
Since most breast lumps are not malignant, breast examination and other investigations are not just a cancer check. Of course, cancer is the most important condition to exclude, but a breast lump can be a cyst, a fibroadenoma or part of generalised fibrocystic change within a breast.
Technique of a clinical breast examination
- A clinical breast exam begins with inspection of the breasts.
- Your top and bra should be off.
- Your healthcare provider checks for differences in size or shape between your breasts. The skin overlying your breasts is checked for abnormalities, such as rashes or dimpling of the skin. Nipples may be checked for evidence of discharge.
- Your healthcare provider will then check each breast, underarm, and collarbone area in a systematic manner for any lumps or abnormalities. I find it helpful to think of the breast as a wheel with spokes. I then follow each spoke from outside to inside until I get back to the starting point.
- Two hands are used to examine and usually two to three fingers of each hand. The breast must also be examined at various depths. Note, the breast should never be squeezed. For women with small breasts, circular movements can be used and large-breasted women, a top to bottom check technique may be used.
- Some women have breast tissue that seems to be full of tiny lumps which extend throughout the breast tissue. This is known as fibrocystic change in the breasts and is not related to cancer.
- All lymph nodes near the breast are examined to see if they are enlarged.
- A suspicious lump needs to be at least the size of a pea before it can be felt in a CBE.
- If a lump is discovered, your healthcare provider will note its size, shape, and texture. He or she will also check to see if the lump moves easily. Benign lumps often feel different from cancerous ones, smoother, rounder and more mobile. But any lump found will likely need to be examined with further diagnostic tests.
Technique of self-examination
Self-examination is vital because it can be done more often than CBE and, if done regularly, you’ll get to know your own breasts and will far more readily know when something is not right. So, don’t underestimate yourself. You’re often the best person for this job.
Self-examination is best done once a month, lying on a bed or in the shower. The arm of the side being examined must be to the side of your body and relaxed. It has often been said that the arm should be lifted above your head, however, this is ill-advised as it can result in overextension of the muscle beneath the breast.
The same techniques that were described for CBE are used for each side in turn. Always use your opposite hand for your left breast and vice versa. Underarms and above collar bones are then examined for swollen lymph glands.
Lumps may vary with your menstrual cycle so it may be good to exclude this first. But, don’t let it cause a big delay in reporting the lump to your doctor so that it can be checked.
Breast cancer is a serious and life-threatening illness. But, knowing that we, all,can have a part to play in preventing its progression, by self-examination, going for clinical breast examinations, and having regular mammography, really can make us feel that we have greater control of this disease and helps us to feel more empowered.
MEET THE EXPERT – Dr Cathy Donald
Dr Cathy Agnew Donald is a medical doctor who has a Women’s Health practice in Somerset West, Western Cape. She has also published two novels The Reluctant Cuckoo and Miles to Go which are both set in SA and tell the story of ordinary people facing extraordinary challenges and learning to overcome them.