Clinical breast examination

A clinical breast exam (CBE) should be performed when a patient presents with symptoms of breast cancer, and it is also part of the triple test used to diagnose breast cancer. It should also be routinely offered at GP appointments once a patient is over 40.

In women with a moderate risk of breast cancer, annual CBE with a clinician should start from 10 years prior to the age of onset for the youngest affected family relative, or starting at 25-30 years of age. In women known to have a genetic mutation related to breast cancer, they should have a clinical breast examination every six to 12 months with a clinician who specialises in breast care from 10 years prior to the age of onset for the youngest-affected family relative or starting from 25-30 years of age.

Performing a clinical breast examination

1. With the patient in an upright position, examine breasts with patient’s arms by their sides, raised above their head and hands on hips while leaning forward (to contract pectoral muscles).
2. Inspect breasts for contours (i.e. erythema, bruised appearance, dimpling or puckering, skin pitting, visible lumps) and nipple distortions (i.e. height, inversion, erythema, eczema, nodules, ulcers).
3. With the patient seated or in a supine position, use the flat of the fingers to palpate both breasts, including all quadrants, axillary tail and around/behind the nipple. Examination should be extended to the axillary and supraclavicular nodes. Large breasts can be immobilised with the non-examining hand.
4. Attempt to reproduce nipple discharge (if any) to determine nature.
5. Record details of any findings (i.e. lumps or signs of malignancy) including size, shape, consistency, mobility, tenderness or fixation. The exact position should be recorded (e.g. o’clock position or centimetres from nipple).