Clinical breast examination and breast self-examination

Abstract

Historically, clinical breast examination (CBE) was a used as a diagnostic tool both to recognize and to diagnose breast cancer. CBE is no longer used to diagnose breast cancer, but rather is currently used as a screening test that can identify areas that might be breast cancer. Many of the observations that students are taught regarding CBE are more appropriate to advanced cancers that were common a century ago than to the smaller cancers seen in current practice. While CBE is less sensitive than mammography, it is nonetheless the primary mode of detecting the 15% of breast cancers that are missed by mammography. Palpation of the supine patient is the essential step to detect almost all cancers that can be detected by CBE. Underlying ribs are the surface against which tissue is palpated. Observing where ribs can or cannot be felt through breast tissue is a useful way to compare different areas of the breasts of a woman and to compare the breasts one to another woman. Breast self-examination (BSE) is an attempt to have women identify their own cancers at an early stage. Although there are many reasons to anticipate that BSE should work, randomized trials of BSE with increasingly sophisticated procedures for retraining and sustaining BSE practice have found that, although there is increased identification of benign breast abnormalities, there is no increased identification of cancer, and no improvement in breast cancer specific survival. Silicone models are widely used to teach both CBE and BSE skills. Nonetheless, there are no data to support claims that these complicated and time-consuming methods of specific patterns and depths of palpation are the optimal way to teach or perform CBE or BSE. © 2010 Springer-Verlag US.