Clinical breast examination: what can be recommended for its use to detect breast cancer in countries with limited resources?

Abstract

Clinical breast examination (CBE) refers to the traditional technique of physical examination of the breast by a health care provider. The examination comprises both systematic inspection and palpation of the nipple, breast, and lymph-draining regions in the axillae and supraclavicular and infraclavicular fossae. CBE is the least studied of the modalities for breast cancer screening. Whereas recommendations for mammography and breast self-examination (BSE) can be based on the findings of randomized screening trials, there have been no randomized trials of CBE alone on which to base recommendations. However, there is considerable indirect evidence from studies that CBE can be recommended as a method for detecting breast cancer for public health benefit. The examination by itself is inexpensive, as no special equipment is required. It is easy to perform, it can be readily taught to health care providers, and it can be offered ubiquitously. CBE should be part of any program for early detection of breast cancer worldwide, provided that follow-up medical and oncology care is available. Physicians and women should be informed about the advantages and disadvantages of this modality, especially as there are no data from randomized trials about the contribution of CBE in detecting breast cancer at an early stage and the absolute benefit of this modality in reducing breast cancer mortality and improving quality of life. Further research on CBE should be promoted, especially in countries with limited resources, to evaluate its efficacy and effectiveness in relation to age, ethnicity, and race.