What to Expect During a Clinical Breast Examination

1
Having Your Clinical Breast Exam

Female doctor with senior patient
Hero Images/Getty Images

The American Cancer Society (ACS) recommends that women 20 to 39 get a clinical breast exam (CBE) once every three years during their annual well-woman visit. Your primary doctor may do one at every yearly check-up. When you are 40 and older, the ACS recommends that you get a CBE annually. Having a clinical breast exam is a great way to keep an eye on your breast health, and many doctors prefer to do one before referring you for a screening ​mammogram.

Your obstetrician/gynecologist, primary care physician, or nurse practitioner can do your CBE for you. If you are seeing an oncologist, the doctor or nurse can perform your clinical breast exam anytime it is needed. Although there are some standards for clinical breast exams procedures, some health professionals have their own variations on the exam.

Knowing what to expect during your clinical breast exam can help you prepare. Your CBE appointment is a good time to ask questions about any breast health concerns that you have. If you need to learn how to do your monthly breast self-exam, ask for some coaching during this visit.

You might like to bring along a record of your menstrual cycle, a list of medications you regularly take, and any other health records that may affect your breast health. Dress comfortably, in clothing that can be removed from the waist up. Try wearing a sports bra or other soft bra that won't put pressure on your breasts, in case you feel a bit tender after the exam.

Let's take a look at some of the steps of a clinical breast exam.

2
Clinical Breast Exam - Visual Examination, Part One

Clinical Breast Exam Visual Check
Clinical Breast Exam Visual Check. Art © Pam Stephan

Your clinical breast exam starts with a visual exam, just like your breast self exam.

You will undress from the waist up and put on a gown. The doctor may begin by asking you questions about your breast health concerns, especially any changes you may have noticed when doing your monthly breast self exam. Be sure to tell your doctor if you have any breast pain, are pregnant or breastfeeding, have had any breast biopsies or surgery, or have a family history of breast or ovarian cancer.

Your doctor will start by doing a visual breast exam. You will be sitting up with your gown open to the front, and your doctor will look for symmetry, skin condition, and nipple changes. Any abnormalities or changes from your previous exam will be noted. If your breasts have changed in size, shape, color, or texture, point these out and discuss them with your doctor. Likewise, if you have nipple discharge, scaly or pitted skin on the breast, nipple, or areola - be sure to ask your doctor to examine these changes.

Clinical Breast Exam - Visual Examination, Part Two

3
Clinical Breast Exam - Visual Examination, Part Two

Clinical Breast Exam - Arms Up
Clinical Breast Exam - Arms Up. Art © Pam Stephan

The visual examination part of your clinical breast exam continues while you are still sitting up. You will be asked to hold your arms overhead, move your arms out to the side, and to put your hands on your hips. This isn't just calesthenics - there are some good reasons for moving your arms during your CBE.

Your breast tissue rests on top of your chest wall muscles. When you move your arms in a symmetrical way, your breasts should also move symmetrically. As you move both arms, your breasts will change shape slightly, and may reveal changes in contour or drape. Nipples may sometimes pull in as you lift your arms. And when your arms are overhead, it is easier for your doctor to see the lymph nodes in your armpits. The way your breast tissue responds to your arm movement gives the doctor some clues about where to focus during the manual part of your clinical breast exam.

4
Clinical Breast Exam - Manual Examination

Clinical Breast Exam Finger Pressure
Clinical Breast Exam Finger Pressure. Art © Pam Stephan

The third part of your clinical breast exam is a manual examination of your breasts. You will be asked to lie down and put your arms back over your head while your breasts are being examined.

As you would do for your breast self-exam, your doctor will use finger-pad pressure to feel all areas of your breast tissue. Breasts are made of fatty and glandular tissue, and will vary in density. Your doctor will palpate each breast with three levels of pressure:

A: Light Pressure for superficial breast tissue
B: Medium Pressue for intermediate layer
C: Deep Pressure for tissue close to chest wall

This is not intended to cause pain or discomfort - but is done to make sure that the manual exam is thorough. If you have pain during your CBE, let your doctor know immediately.

Any breast lumps or shape changes will get special attention - as well as the way the lumps respond to pressure and move within breast tissue. The size and location of any lumps and bumps will be noted, and if you will be having a screening mammogram, you radiologist will pay special attention to those areas.

5
Clinical Breast Exam - Lymph Node Examination

Clinical Breast Exam Lymph Node Locations
Clinical Breast Exam Lymph Node Locations. Art © Pam Stephan

The fourth part of your clinical breast exam is a manual examination of your lymph nodes. The nodes are located in clusters above and beside your breasts. It is important to check these for swelling because that can indicate infection or inflammation. In case of a breast tumor, cancer cells can travel to nearby lymph nodes and cause them to swell. Lymph node status is an important part of a breast cancer diagnosis.

Your lymph nodes in your armpits, over your collarbone, and your neck will be palpated to see if they are swollen or normal. In the picture, you can see the position of the nodes that will be checked:

A: Cervical nodes on your neck
B: Supraclavicular nodes just above your collarbone
C: Infraclavicular nodes just behind your collarbone
D: Axillary nodes in your armpit

6
Clinical Breast Exam – Nipple and Areola Examination

Clinical Breast Exam Nipple Check
Clinical Breast Exam Nipple Check. Art © Pam Stephan

The last part of your clinical breast exam is a manual examination of your nipples and areolas. When you do your monthly breast self-exam, you may notice some nipple changes - bring these to the attention of your doctor.

The doctor will check for nipple discharge, skin color, and position. Be sure to tell your doctor if you have any nipple pain, are pregnant or breastfeeding, have had any breast surgery, or have a family history of breast or ovarian cancer. If there is any nipple discharge other than breast milk, it may be sampled and sent for lab tests.

Your doctor will check your nipple position by gently squeezing either nipple with the index and middle fingers and pulling forward. They will watch to see if the nipple springs back into place, or if it pulls back into the breast.

Your areolas will also be examined, to see if you have any pain or swelling beneath them, as that may be a subareolar abscess. If the areola is bumpy, persistently itchy, red, scaly, or tingles, it could be an infection or Paget's disease of the nipple, a type of breast cancer.

7
Clinical Breast Exam – Benefits to Remember

Your clinical breast exam is an early detection tool that benefits you. When followed by a screening mammogram, your CBE is a great way to check your breasts for benign breast conditions or breast cancer. Smaller tumors (less than 2cm) usually respond to treatment better than larger ones, and are associated with longer survival rates.

If you notice changes in your nipples or find a breast lump, you should schedule a clinical breast exam for a professional opinion and get help. Don't wait until your regular appointment for a physical exam if you are concerned about changes in your breasts. Get a CBE when you see or feel changes that appear to be worrisome.

The American Cancer Society (ACS) recommends that women 20 to 39 get a CBE once every three years during their annual well-woman visit. Your family doctor may do one at every yearly check-up. Women 40 and older are recommended to get a CBE annually. Keep up with your monthly breast self-exam, get regular exercise, stay slim, stick to a healthy diet, and make smart lifestyle choices. Team up with your doctor for your best breast health.

Sources:

Can Breast Cancer Be Found Early? American Cancer Society. Last Revised: 09/18/2009

Understanding Breast Changes: A Health Guide for Women. Check With Your Health Care Provider About Breast Changes. National Cancer Institute. Posted: 09/28/2009.

Clinical Breast Examination: Practical Recommendations for Optimizing Performance and Reporting. Debbie Saslow, PhD, Judy Hannan, RN, MPH, Janet Osuch, MD, MS, et al. CA Cancer J Clin 2004; 54:327-344.

Continue Reading