Breast Exam

Dr. Ruth Westra

Applied Anatomy

September 17, 2007

Goals/Objectives

Discuss Asymptomatic Female/Male Breast Assessment

Practice on Silicone Models Demonstrate Proficiency with clinical

breast exams on a professional patient model at the Duluth Family Medicine Residency

Anatomy

Milk producing glands arranged into lobules Glands connected by series of ducts to form a

common drainage path at the nipple Nipple surrounded by the areola Fibro-elastic and fatty tissue provide support Lymphatic tissue with ~90% drain into the

ipsilateral axilla and 10% drain into the Internal Thoracic nodes

EPIDEMIOLOGY

The lifetime risk for developing Breast Ca in US women is 1 in 7

Majority of women who develop breast Ca are over age 50

Majority of women with Breast Ca have no obvious risk factors

RISK FACTORS

Age Gender Race Prior History of Breast Cancer Family History of 1st Degree Relative Prolonged/Uninterrupted Exposure to

Estrogen

GAIL MODEL

Breast Cancer Risk Assessment Tool to calculate 5 year and lifetime risk for breast cancer based on several factors

Relative Risk for each factor produces a composite score

http://www.cancer.gov/bcrisktool/

SCREENING GUIDELINES

Clinical Breast Exams (CBE) part of periodic health exam every three years from women in 20s and 30s and yearly for women 40 and over.

Yearly mammogram starting at age 40 and continuing for as long as a woman is in good health.

Breast self-exam (BSE) is an option for women starting in their 20s

Women at increased risk should talk with their doctors about the benefits and limitations of screening earlier.

Taking Care of Your Breasts

Clinical Breast Exam (CBE) Mammogram Breast Self-Exam (BSE)

CLINICAL BREAST EXAM

Every 3 years for women age 20-39 Annually for women 40 and older

CLINICAL BREAST EXAM

Detection for some cancers that are missed on mammography

Follow-up on “lumps” detected by women

Screening younger women Screening women who do not follow

mammography recommendations

EXAMINATION IN DETAIL

Explain Exam Room Appropriate Draping Inspection Position Palpation

SEVEN P’s FOR EXAM

Position Perimeter Palpation Pattern

Pressure Patient Education Plan of Action

PATIENT EDUCATION AND PLAN

Discuss your Exam with the patient Check for patient understanding and

agreement Offer written material Recommend appropriate screening Document your Exam Findings Document your Patient

Recommendations

DOCUMENTATION

location size shape consistency

texture mobility tenderness

PLAN

Document your Exam Findings Document your Patient

Recommendations

COMMON ERRORS IN CBE

Missing the Auxiliary Tail Inconsistent Pressure Pattern of Search does not extend to the

Perimeter Avoiding the Nipple/Areolar Complex

MAMMOGRAM GUIDELINES

Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health.

BREAST SELF-EXAM

Option starting at age 20 and older monthly

Women should report any breast change promptly

BREAST MASSES

Fibroadenoma Cysts Breast Cancer

Clinical Pearls

A clearly identifiable discrete mass requires a biopsy even if the mammogram is negative

Breast Cancer can occur in men Breast Cancer can occur in young

women If you have uncertainty, seek input

References

www.cancer.org http://medicine.ucsd.edu/clinicalmed/ Bickley, L.S. Bate’s Guide to Physical

Examination and History Taking Ninth Edition Saslow et al. “Clinical Breast Examination:

Practical Recommendations for Optimizing Performance and Reporting CA: A Cancer Journal for Clinicians Vol 54, No 6 Nov/Dec 2004

Sharon Anderson NP UMD Health Service