Breast cancer is the most common cancer among American women, affecting 200,000 and killing over 40,000 women each year. There is good news, however, according to Madeline Ellis of Health News: thanks to early detection efforts, death rates have declined two percent per year since 1990--sparing 650,000 lives. Early detection is based on three components: breast self-exam, mammogram, and clinical breast exam, CBE. The CBE plays an important role, as some lumps can be felt but do not show up on mammograms.
Protocol
The CBE may be performed by a physician, nurse practitioner, physician's assistant, or nurse. According to the American Cancer Society, women without high risk factors between the ages of 20 and 39 should have a CBE every three years and women ages 40 and older should have a CBE every year. Women with a family history of breast cancer or who have genetic factors that put them at high risk should speak with their health care providers to determine the ideal CBE frequency.
Procedure
The entire CBE typically takes no longer than 10 minutes. It begins with a complete history, including the start and regularity of the woman's menstrual cycle, pregnancies, past and present use of oral contraceptives, hormone replacement therapy and other medications, and any changes the woman has noticed in her breasts.
The second part of the CBE involves observation for differences in size, shape, and appearance between the breasts, including the nipples. Breast tissue extends from the collarbone to beneath the arm and down to the ribcage; the entire area is inspected with the woman's hands over her head, on her hips, and while leaning forward and flexing her chest muscles.
The final part of the CBE is palpation, or feeling for masses. This is done while the woman is both sitting up and lying down, arms raised, to ensure that all areas of breast tissue have been examined.
Follow-up
According to the United Breast Cancer Foundation, most suspicious lumps turn out to be benign. Accordingly, when a health care provider discovers an abnormality during a CBE, she may recommend that a woman return in one month for a repeat exam before pursuing further testing. If, however, her clinical judgment dictates that immediate action be taken, she may schedule a diagnostic mammogram, breast ultrasound, or breast biopsy.
Accuracy
The accuracy of the CBE is dependent upon the skill of the practitioner and location of any abnormalities. A team of physicians led by Dr. Joann Elmore found that the chance of false-positive results--the finding of an abnormality that turns out to be benign--is approximately 22 percent after 10 CBEs. Though that may seem high, the chance of false-positive results with mammograms is even higher at 49 percent after 10 procedures. The Susan G. Komen for the Cure Foundation cautions women to be prepared for such an eventuality, reminding them that regular screening does save lives.
Implications
Women can increase the effectiveness of CBEs by becoming familiar with their breasts and performing monthly breast self-exams. This will allow them to point out to their provider any changes they notice, and to schedule a CBE to investigate any concerns. Clinical breast exams are a vital component of early detection of breast cancer and should become a part of every woman's health regimen.
References
- "New England Journal of Medicine"; Ten-Year Risk of False Positive Screening Mammograms and Clinical Breast Examinations; Joanne Elmore, Mary Barton, Victoria Moceri, Sarah Polk, Philip Arena, and Suzanne Fletcher; 1998
- Health News: Cancer Death Rates Continue to Decline in the U.S.
- Susan G. Komen for the Cure: Clinical Breast Exam
- United Breast Cancer Foundation: Clinical Breast Exam
- American Cancer Society: Overview: Breast Cancer
