Clinical Breast Exam
(CBE)

General Approach

  • Sensitivity & Awareness
  • Communicate & Educate
  • Talk Before Touch
  • Explain Procedure and Purpose

 

Patient Preparation
  • Patient is seated.
  • Ask patient to lower gown.
  • Arms at side.
  • Perform visual inspection.


Arms Over Head
Check For:
  • Contour
  • Dimpling
  • Flattening
  • Nipple Retraction
    		•


    Arms On Hips
    Observe factors that influence breast appearance:
    • Shape
    • Symmetry
    • Color
    • Surface
    • Size
    • Augmentation

     

    Bimanual Compression
    To Discover Masses Not Palpable In Supine Position
    • Cup breast in one hand.

    • Compress tissue in vertical strips.

    • Start in midaxillary region, proceed in parallel strokes
      to midsternal line      .

     

    Documentation

    Two methods may be used for the documentation and description of the breast.

    1. The breast may be divided into 4 quadrants - upper and lower outer quadrants and upper and lower inner quadrants.

    2. The breast is described in reference to the face of a clock. A mass or finding maybe located by the quadrant or by the "time and distance from the nipple.

    Example: 2-3 cm stony mass, palpated 4 cm from the nipple at the 10 o'clock position

     

    Nipple Compression
    Check For Discharge
    • Isolate the lobe producing discharge.

    • Elicit discharge from periphery to nipple.

    • Distribute pressure evenly from each number position on the clock.

    • Document location.

     

    Basic Hand Technique
    • Use the pads of the three middle fingers.
    • Use three depths of pressure.
    • Move in small circles lasting about a second each.
    • Advance about 1 finger width each pass.

     

    Lymph Node Palpation

    Explain The Procedure
    • Verbally forewarn the patient before touching.
    • Support the patient's arm.
    • Reach high into the axilla.

     

    Lymph Node Palpation
    Check
    • Central Nodes
    • Pectoral Nodes
    • Lateral Nodes
    • Subscapular
    • Infraclavicular
    • Supraclavicular
    • Check for enlargement of nodes.
    • Check along the spine for masses or tenderness which may represent metastases.
    • Repeat the same examination on the other side.

     

    Breast Tissue Examination
    Palpate
    • breast tissue
    • nipple
    • aerola
    • Explain the procedure.
    • Stand on same side as breast you are examining.
    • Completely examine one breast at a time.

    Remember: The consistency of breast tissue varies with age.

     

    Breast Palpation
    Palpate
    • midaxillary
      region

    • inframammary
      ridge

    • clavicle
    • mid-sternum
    • Position a pillow under the patients shoulder as shown.
    • This spreads the breast tissue evenly across the chest wall.
    • Palpate using vertical parallel strips.
    • Remove the pillow when the nipple is reached.
    • Completely examine one breast at a time.

     


     

    Male Breast Tissue

    1400 men per year
    develop breast cancer.

    Commonly presents as:

    • Subareolar mass.
    • Mass in upper outer quadrant.

    Developed male breast tissue may indicate:

    Examination of the male breast should not be omitted. The underdeveloped breast tissue in some men may be palpated as a firm button of tissue 2 cm or more in diameter. This thin disc is covered by a small nipple and aerola. Perform a visual inspection and palpate the areola and nipple for masses, nodules, swelling and ulceration. Men do not need to have mammograms.

     

    Key Points to Remember


    Patients should be reminded of the importance of monthly breast self exams.

    Breast cancer risk increases with age. Yearly mammograms and CBE's are recommended:

    • Clinical Breast Exam should be performed every year for women beginning at age 20,
    • A baseline mammogram should be established by age 40.

    Women in higher risk groups should be given personal recommendations based on their individual risks.

    For further guidelines see: