From the Guidelines
To palpate the breast for lumps or anomalies, use the finger pads of the middle three fingers to palpate one breast at a time with overlapping dime-sized circular motions, thoroughly searching the upper outer quadrant and under the areola and nipple, as these are the most common sites for cancer to arise. When performing the palpation, it is essential to follow a systematic approach to ensure all breast tissue is examined. The patient should be positioned in a way that allows for easy access to the breast tissue, such as lying down with a pillow under the shoulder on the side being examined and the arm behind the head 1. The examiner should use light, medium, and deep pressure to feel all breast tissue from the collarbone to the bottom of the breast and from the armpit to the breastbone. It is also crucial to examine the nipple, but instead of squeezing, the tissue at and beneath the nipple should be palpated, as squeezing can cause discharge and discomfort 1. The armpit area should also be checked for enlarged lymph nodes.
Some key characteristics to consider during palpation include the position of the patient, the perimeter of the breast tissue, and the pattern of search. The patient should be sitting for palpation of the axillary, supraclavicular, and infraclavicular lymph nodes, and lying down for breast palpation, with the ipsilateral hand overhead to flatten the breast tissue on the chest wall 1. The examiner should use a systematic pattern, such as a "vertical strip" pattern, to search the full extent of breast tissue.
It is also important to note that breast tissue naturally has a nodular texture, and a systematic approach helps detect changes. If any new lumps, changes in breast size or shape, skin dimpling, nipple inversion, or discharge are found, a healthcare provider should be consulted promptly for proper evaluation. Regular self-examination, ideally once a month, 3-5 days after the period ends when breasts are least swollen, can help detect changes and improve outcomes 1.
From the Research
Palpation Techniques
To palpate the breast for lumps or anomalies, the following steps can be taken:
- Lie down or stand upright with arms at sides or above head to make the breast tissue more accessible
- Use the pads of the fingers to feel for lumps or thickening in the breast tissue, covering the entire breast area
- Check for any changes in the shape or size of the breast, as well as any dimpling or puckering of the skin
- Squeeze the nipple to check for any discharge or bleeding
Comparison of Self-Examination and Clinical Examination
Studies have compared the efficacy of breast self-examination (BSE) and clinical breast examination (CBE) in detecting breast cancer:
- A study published in 2022 found that there was no statistically significant difference between CBEs and BSEs in identifying cancer or positive ultrasound findings 2
- Another study from 2015 found that both self-detection and CBE showed similar mean tumor diameters, and that tumors located in the central region of the breast were significantly larger than those in peripheral regions 3
- A review published in 2011 suggested that screening by CBE with the teaching of BSE may be effective in reducing breast cancer mortality in countries where breast cancer is diagnosed at an advanced stage 4
Effectiveness of Breast Exams
The effectiveness of breast exams in detecting breast cancer has been studied:
- A study published in 2003 found that breast self-examination did not have a beneficial effect on breast cancer mortality, and that it may even cause harm due to increased biopsies with benign results 5
- A study from 2020 discussed the potential benefits of BSE and CBE in facilitating earlier detection of breast cancer in populations with advanced stages at diagnosis 6
- A study from 2022 found that 25 of 26 breast cancers were initially detected by patients, while only one was detected by CBE, suggesting that BSEs can be effective in detecting breast cancer 2