Physical Breast Exams Helpful in Detecting Breast Cancer (dateline June 27, 2000)
With the increased emphasis on mammography as the gold standard in breast cancer detection, many women wonder if physician performed clinical breast exams are still necessary. While the majority of breast cancers (up to 85%) are detected on x-ray with mammography, a new study published in the Journal of the National Cancer Institute finds that clinical breast exams are also useful in helping to detect breast cancer.
In studying 752,081 cases, researchers found that clinical breast exams performed by physicians helped to detect 5% of breast cancers that did not show up on mammography. This reveals that clinical breast exam, along with breast self-exam and mammography, is an essential part of the breast cancer diagnostic process .
According to the researchers, clinical breast exams can even detect very small breast cancers, once thought to only be noticeable with mammography. In the study, more than 50,000 clinical breast exams revealed abnormal findings. Of these cases, breast cancer was confirmed in 3,780 of the women.
Lead researcher Janet Kay Bobo, MD says that clinical breast exam helped detect breast cancer in a small percentage (5%) of women whose mammograms did not show an abnormality. On the other hand, many of the women who had abnormal findings during clinical breast exams were found not to have breast cancer. According to Dr. Bobo, this may help women who do find a worrisome area during physical exam to not panic while they undergo a mammogram and further breast imaging (with ultrasound or other imaging tests).
Dr. Bobo emphasizes that physicians need to spend more time instructing women on how best to perform breast self-exams on their own. According to Cornelia Baines, MD, who wrote an accompanying editorial in the Journal of the National Cancer Institute, women tend to look for signs of advanced breast cancer when performing breast self-exams. While it is important to look for skin dimpling, large lumps, and changes around the nipple, it is equally important to look for more subtle signs of change.
According to Dr. Baines, women should also check for asymmetry in the breasts (differences between the two breasts). When standing in front of the mirror, women should put their hands on their waist and rotate, examining the side profile of each breast. Women should also raise their arms and look for small abnormalities, such as a slight indentation or flattened curve of one breast when compared to the other. After this is completed, women should proceed to look for other warning signs, such as:
- Any new lump or hard knot found in the breast or armpit
Any lump or thickening that does not shrink or lessen after menstruation
- A thickening or swelling of the breast
- Any dimpling, puckering or indention in the breast
- Dimpling, skin irritation or other change in the breast skin or nipple
- Redness or scaliness of the nipple or breast skin
- Nipple discharge (fluid coming from the nipples other than breast milk), particularly if the discharge is bloody, clear and sticky, dark, or occurs without squeezing the nipple
- Nipple tenderness or pain
- Nipple retraction: turning or drawing inward or pointing in a new direction
- Any breast change that may be cause for concern
The key is for women to get to know their breasts so that when they perform self-exams each month, they can notice subtle changes and alert their physicians.
While the study does find that clinical breast exams performed by physicians are a necessary part of breast cancer detection, the findings do not de-emphasize the importance of mammography. Mammography helps to detect the majority of breast cancers and can detect breast cancer early when the chances for minimally invasive treatment and survival are the greatest. According to the American Cancer Society:
- All women between the ages of 20 and 39 should practice monthly breast self-exams and have a physician performed clinical breast exam at least every three years.
- All women 40 years of age and older should practice monthly breast self-exams, have yearly clinical breast exams, and begin yearly screening mammograms .
- Click here for more information on these guidelines.
Women with a family history of breast cancer or those who test positive for the BRCA1 (breast cancer gene 1) or BRCA2 (breast cancer gene 2) mutations may want to talk to their physicians about beginning annual screening mammograms earlier than age 40, as early as age 25 in some cases.
Physician often stress the importance of the “triple test” to detect breast cancer. The triple test consists of physical breast exam, mammography, and ultrasound. If an abnormality is found with any one of these tests, breast biopsy or further testing may be warranted. Note: breast ultrasound is not a breast cancer screening test. Ultrasound is generally used to investigate a breast concern.
- An abstract from the study discussed in this article is available at http://jnci.oupjournals.org/cgi/content/abstract/92/12/971
- The June 20, 2000 WebMD report by Elizabeth Tracy is available at http://my.webmd.com/content/article/1728.58604
- The June 20, 2000 Reuters Health report, “Clinical Breast Exams May Improve Early Cancer Detection,” is available at http://www.reutershealth.com/archive/2000/06/20/eline/links/20000620elin009.asp
- To learn more about clinical breast exam, please visit http://www.imaginis.com/breasthealth/earlydetection.asp#cbe
- To learn more about breast self-exam, please visit http://www.imaginis.com/breasthealth/bse.asp
- To learn more about mammography, please visit http://www.imaginis.com/breasthealth/mammography.asp