It is imperative that a clinical examination is conducted annually by a breast specialist. This clinical examination does not replace a mammogram but acts as a complementary exam in detecting lesions and is classified as one of the most important routine exams that every woman should have.
What does the clinical breast examination involve? (palpation)
- First of all an overview of the breasts. With the woman initially in a sitting position with the hands on her waist the circumference of the breasts, the colour and the features of the skin, the existence of any lump or intrusion, the nipples and the symmetry of the breasts are checked. Following that, the specialist asks the examinee to raise her hands upwards observing if there is symmetry in the passive movement of the breasts as the hands are raised or if any of the breasts is lagging behind compared to the other which would indicate a malignant tumor that adheres to the chest wall causing a relevant stiffness of the breast. The specialist would also observe if any lumps or intrusions appear that did not appear before in the passive position of the breasts.
- Then, the patient lies on her back with the hands resting above the head. The doctor performs the examination by gentling pressing the breast on her chest and her sides with mild circular movements of the fingertips so as to detect the existence of masses and study its nature.
- After that, follows the examination of the nipples. Their symmetry or possibly any intrusions, the colour and the feature of the skin are observed. Any potential fluid excretion from the nipples is also checked, the type and the colour of the fluid. It is forbidden to press the nipples unless the reason for the visit is the excretion of the fluid from the nipple. If no fluid is excreted during the examination a mild pressure is allowed on the nipple to confirm the symptom and the extraction of cytological examination of the fluid.
- The examination of the breasts is completed with the palpation of the armpit and neck for the existence of any lymph nodes. As previously mentioned, the existence of palpable lymph nodes in the armpit or their detection in a mammography is a usual phenomenon in most cases. Axillary lymph nodes might have been there years ago as a result of old infections. It is also likely that they are enlarged in cases of traumas, surgeries or inflammation on the hand, fingers or nails. In these cases they are slightly painful. We are only worried if the co-exist with a suspicious mammograph finding, are only present in one armpit, are painless, hard, stiff and did not pre-exist.
At which point of the menstruation cycle is it better to have the examination?
As mentioned before, in every woman, since the breasts change in size as menstruation days approach, a palpable mass may make its appearance and then disappear after a woman’s period is over. Therefore, the most suitable days for a clinical examination in pre-menopause women is as soon as their period is over by up to a week later. It is recommended that they should arrange for an appointment for a precautionary breast examination in one of those days once a year. Of course, if they notice something suspicious on their breast during that time they should see their doctor earlier. For older women who do not have periods, no such limitation exists.
How often should breast examination take place?
Clinical examination of the breasts should take place as a precautionary measure once a year to women over 30 or more often if there is family history of breast cancer and according to the instructions of the specialist. Despite the fact that breasts are an organ that is exposed and therefore easily accessible, their examination is not simple especially in young women. There are breast nodules and masses that even an experienced examiner has trouble distinguishing them with certainty if they are benevolent or malignant. Detailed study of the patient’s history is of high importance that should be made ahead of the clinical examinations. This will help to diagnose especially in cases of diagnostic doubts. With a good medical history an experienced mammologist already has in his/her mind the most likely diagnosis before he/she even touched the hand of the patient.
Will regular breast examination be a specialist mammologist mean that if cancer is spotted it is curable?
Not necessarily. Clearly the sooner a malignant breast tumor is spotted, the less chances of metastasising elsewhere and the sooner the treatment starts the bigger the chances of being cured. The mammologist can palpate a breast tumor when it is very small years before the patient calls and months or even years before non specialised doctors palpate it. Thus this will give her more chances of saving her life. It is also certain that even when the most specialised medical hand locates a malignant tumor, this was not created a few days ago but it must have pre-existed in smaller, non-palpable size at an average of two years. Cancer is a long-standing process. Truth is that it started at some point by one cell that for some reason started to multiply slowly but uncontrollably. Therefore, for a long time, depending on the kind, is neither palpable or detected through imaging examinations or blood tests. How fast or slow its evolution is during that time depends on the genes. These hide its aggressiveness. Timely detection of the cancer by a mammologist will lead to an early start of the treatment and will significantly increase the possibility of beating cancer.
At what size does a tumor becomes detectable?
Women who self examine can detect a breast tumor if their diameter exceeds 3 centimeters. Doctors who are not trained in breast diseases can palpate it when it is around 2 centimeters. A mammologist can palpate it when it is around 1 centimeter. Mammography can even detect cancer at an initial stage that has the size of a few millimeters as long as it is about a tumor that is visible in mammography.