Clinical Breast Examination Guidelines

Introduction to Clinical Breast Examination

A proper clinical breast examination requires a systematic approach including clinical history, visual inspection, and palpation using specific techniques to thoroughly examine all breast tissue and nearby lymph nodes, as recommended by the American Cancer Society 1, 2

Identify screening practices including previous breast self-examinations, clinical breast examinations, and mammograms, and assess risk factors including age, personal history of benign breast disease, and family history, according to the American Cancer Society 3
Ask about any breast changes including skin/nipple changes, lumps, pain, itching, or spontaneous nipple discharge, as suggested by the American Cancer Society 3

Position the patient sitting with hands pushing tightly on hips to contract pectoralis major muscles and enhance identification of asymmetries, as recommended by the American Cancer Society 2
View breasts from all sides, assessing symmetry in breast shape or contour, skin changes, and nipple changes, according to the American Cancer Society 2
Remember the acronym BREAST for signs of advanced breast cancer: Breast mass, Retraction, Edema, Axillary mass, Scaly nipple, and Tender breast, as suggested by the American Cancer Society 2

Begin with the patient sitting to palpate axillary, supraclavicular, and infraclavicular lymph nodes, as recommended by the American Cancer Society 4
Position the patient lying down with ipsilateral hand overhead to flatten breast tissue on chest wall, and use the finger pads of the middle three fingers to palpate one breast at a time with overlapping dime-sized circular motions, according to the American Cancer Society 4
Cover the entire pentagon-shaped area of breast tissue using specific landmarks, and use a vertical strip pattern to ensure thorough coverage of all breast tissue, as suggested by the American Cancer Society 4, 5, 6
Pay special attention to the upper outer quadrant and the area under the areola/nipple, as these are the most common sites for cancer to arise, according to the American Cancer Society 4, 7
Apply three levels of pressure in sequence at each area: light, medium, and deep, as recommended by the American Cancer Society 4, 5

For women with breast implants, the examination technique remains the same as implants are placed behind breast tissue, as suggested by the American Cancer Society 4
The examination duration should be adequate for thoroughness, which may take several minutes for an average-sized breast, according to the American Academy of Family Physicians 6
Explain to the patient that a thorough examination takes time to avoid misunderstandings, as recommended by the American Academy of Family Physicians 6

Failing to inform patients about the examination process beforehand, which can cause discomfort and misunderstanding, as noted by the American Cancer Society 4
Using inadequate pressure levels during palpation, missing deeper lesions, as suggested by the American Cancer Society 4, 5
Incomplete coverage of breast tissue by not following the pentagon-shaped perimeter, as recommended by the American Cancer Society 4
Squeezing the nipple instead of gentle palpation, as noted by the American Cancer Society 4
Rushing the examination, as thoroughness is essential for detection, according to the American Academy of Family Physicians 6