Clinical Breast Exam
Q: What is a Clinical Breast Exam or CBE?
A clinical breast exam, often called a CBE, is a thorough breast exam done by a medical provider well trained in breast examination technique. Because the exam is more thorough, you can expect the exam to take longer than an examination with your primary care provider or OB/GYN. The underarm/axilla area will also be examined to check for any enlarged lymph glands.
Q: When should a woman start getting CBE’s and how long should she continue to get them?
Women should begin getting CBE’s at the age of 20. Women between 20 and 39 years of age should get a CBE every 2 or 3 years, usually at the time of the Pap and Pelvic exam. Women age 40 and over should have a CBE yearly. Some national guidelines state women can stop getting CBE’s at the age of 70: however, breast cancer can occur at any age. You are encouraged to speak with your medical provider regarding continuing CBE into your 80’s or even 90’s.
Q: Should I do self breast exam (SBE)? When do I start?
Research on SBE remains controversial regarding the benefit of the procedure. When performed regularly and correctly every month, SBE is helpful in identifying abnormalities in the breast. SBE performed infrequently or incorrectly is of little value. SBE performed on an irregular schedule may contribute to unnecessary diagnostic procedures and surgery.
If you feel you would like to perform monthly self breast exams, the recommended age to start is 20. Women who are menstruating should perform the exam monthly on the 5th -10th day after the start of your period. Women who are no longer menstruating should pick a particular day of the month and perform the exam every month on that date. We recommend the up and down or strip method demonstrated in the picture.
Q: At what age should a women have her first screening mammogram and how often thereafter?
The American Cancer Society guidelines for the detection of breast cancer in asymptomatic women are:
Women 40 and older should have a mammogram every year. The American College of Radiology also recommends yearly mammograms and yearly physical examinations starting at age 40. The most recent clinical trials for screening mammography indicate that the benefit of screening mammography for women in their forties is at least a 24% decrease in death rates due to breast cancer.
It is very important to remember that approximately 90% of all breast cancers can be detected by mammography. Therefore, yearly health care professional examinations are very important for detection of cancer not visible with mammography. When yearly mammography and yearly health professional examination are utilized in combination as recommended, potential detection of cancer at its earliest stage is possible. Most insurances including Medicare pay for one screening mammogram per year beginning at age 40. After age 65, Medicare and some insurances pay every other year. You may need to check with your insurance for clarification.
*** Due to the existing controversy regarding the frequency of screening mammography, the Guidelines from the American Cancer Society will remain in place at the Breast Center. We will continue to evaluate the recommendations from the nationally recognized sources that make screening recommendations. Updates to the website will be made when the current confusion has resolved.
Q: What is a digital mammogram
Most hospitals and mammography clinics have switched from the older model analog films to the newer digital technique or plan to switch in the future. Digital Mammography is available at all mammography sites affiliated with SIU School of Medicine. In addition, if you are one of our previous patients, there is a high probability your mammography films from recent years have been converted to digital. Digital mammography is used for both screening and diagnostic mammography. The technique is computerized and allows the radiologists to easily enlarge sections of the mammogram they wish to view closer. It also allows them to manipulate the films to view at various angles allowing better visibility of the suspicious area on the breast. Digital mammography has almost totally eliminated the use of the radiology “films” familiar from previous mammography experiences.
Q: What is the difference between a screening and a diagnostic mammogram?
A screening mammogram is an examination using low dose X-rays to evaluate the breast for potential abnormalities and provides a general overview of the breasts. A screening mammogram is not intended to diagnose cancer but rather screen out patients who will require additional evaluation in the search for potential breast cancer. If a questionable abnormality is detected on the screening examination, a more detailed diagnostic mammogram is required. The diagnostic mammogram is performed using special X-ray views (i.e., magnification, spot compression, etc.) which allow a detailed evaluation of the region of interest. Approximately 10% will be recalled after the screening mammogram for additional diagnostic evaluation.
Q: Are the recommendations different for women who have a positive family history of breast cancer?
For women with a positive family history of breast cancer in a premenopausal first-degree relative (mother, sister, or daughter diagnosed before age 50), screening is suggested to begin ten years before the earliest breast cancer occurrence in the family, but not before age 25. Example: If a mother is diagnosed with cancer at age 45, then all daughters and younger sisters should start screening mammography at age 35. Currently, there is no information to suggest that screening intervals shorter than one year are beneficial, even in women who have a strong family history of breast cancer.
Q: What is the appropriate exam for a patient under the age of 30 with a palpable lump?
In general, young, pregnant, or lactating women with abnormal breast lumps should be evaluated with breast ultrasound as the first imaging study. Mammography is conducted on young patients when the ultrasound examination is inconclusive or suggests the presence of breast cancer. However, in young women with fatty breasts or who have several children, mammography can frequently provide valuable information since dense breast tissue is no longer a limiting factor. What is important to understand is that although the examination sequence to evaluate patients younger than age 30 may be different, the same diagnostic process to arrive at the diagnosis is still used. This individualized workup requires a highly trained mammography specialist well trained in breast disease.
Q: What is the appropriate process for younger women with breast pain
Patients with diffuse breast pain or tenderness usually require reassurance, without the need for breast imaging studies. Localized breast pain, which the patient repeatedly pinpoints the region of pain, is rarely associated with breast cancer. However, when present and persistent, such cases merit a diagnostic evaluation with ultrasound and/or mammography. If a young patient presents with secondary signs of breast cancer (skin thickening, retraction, bloody nipple discharge, large mass, etc.), the initial examination is usually mammography, supplemented by additional examination and biopsy, if needed. A thorough history of the breast pain and possible precipitating factor is obtained.