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Clinical Breast Exams Can Be Improved With More Standardization (dateline October 12, 1999)

A new study reveals that clinical breast examinations performed by health care professional are not consistent. A more standardized technique could lead to earlier breast cancer diagnoses, and in turn, could reduce the breast cancer mortality rate.

Presently, most physicians do perform breast examinations and advise women to conduct breast self-examinations (BSE) on a monthly basis. However, research shows that the method doctors use to conduct the examination and the instructions they give to their patients on how to perform BSE at home vary considerably. "There should be a standardized method. The exams are not being done in a consistent way," said Susan Nathanson, executive director of Y-ME National Breast Cancer Foundation. "From one doctor to the next, a woman might get a different exam."

Studies reveal that clinical breast exams (CBE) are essential in detecting breast cancer and may find up to forty-five percent of cancers missed by mammogram. Dr. Mary Barton, an instructor of ambulatory care and prevention at Harvard Medical School stresses the importance of clinical breast exams in addition to mammography. "Mammograms are based on the x-raying of breast tissue, but some cancers are the same density as surrounding breast tissue [and don’t show up on x-ray.]"

Researchers, funded in part by the Harvard Pilgrim Health Care Foundation, recently reviewed 110 published articles on breast exams from 1966 to 1997 and determined five variables that tend to affect breast cancer exam results:

  • the position a patient lies during the exam
  • breast boundaries
  • the examiner’s finger position, movement, and pressure
  • the duration of the exam
  • exam search patterns

Researchers discovered that examiners who moved their fingers in very small circles in up and down motions overlapping strips of the breast (the "lawn-mover" style) were able to cover more breast surface area than examiners using concentric circular motions around the breast.

The study also revealed that most physicians do not spend enough time on the breasts during routine physical examinations. Researchers determined that the average breast exam should take six minutes, compared to an average of 1.8 minutes physicians typically spend giving exams and discussing BSE with patients.

The American Cancer Society encourages all women to have clinical breast exams and recommends the following guidelines for breast cancer prevention:

  • Women between 20-39 years of age should perform breast self-examination (BSE) every month and have a clinical breast exam (CBE) at least every three years.
  • Women over 40 should have an annual mammogram, an annual clinical breast exam, and perform BSE on a monthly basis.

For more information on clinical breast exams and guidelines for breast cancer screening, please visit

This article references the October 6, 1999 report "More Standardization Could Improve Breast Exams" in the Medical Tribune available at The original report, "Does ThisPatient Have Breast Cancer? The Screening Clinical Breast Examination: Should It Be Done? How?," was published in the October 6, 1999 issue of the Journal of the American Medical Association and is available at