By Stephanie Peltzer, Medical Tribune News Service
A standardized technique for conducting clinical breast exams is
needed and could lead to more cases of breast cancer being
diagnosed early, according to a new study.
Although manual breast exams are performed in physicians'
offices and women are advised to do self-examinations, there is no
standard method for performing the exam, and many physicians may
not be doing an adequate job.
``There should be a standardized method. The exams are not being
done in a consistent way,'' said Susan Nathanson, executive
director of Y-ME National Breast Cancer Foundation. ``From one
doctor to the next, a woman might get a different exam,'' she said.
A standard method of breast cancer exams could make exams more
reliable, and would likely increase early detection by improving
examiners' sensitivity to lumps, according to the study.
Clinical breast exams are crucial in detect breast cancer.
Previous studies have found that they detect from 3 percent to as
many as 45 percent of cancers that mammograms miss.
The American Cancer Society recommends that women over the age
of 40 have an annual breast exam conducted by a physician as well
as an annual mammogram. Recommendations for women ages 20 to 39 are
to have a clinical breast exam every three years. The society also
suggests that women perform a self-exam every month.
Unfortunately, the ability of examiners to detect cancerous and
benign lumps in women is not consistent. Failure to diagnose breast
cancer is a leading reason for malpractice claims.
As important a tool as mammography is, it cannot find all
tumors. ``Mammograms based on x-raying the of breast tissue,'' said
lead researcher Dr. Mary Barton, an instructor of ambulatory care
and prevention at Harvard Medical School in Boston, Mass. ``Some
cancers are the same density as surrounding breast tissue [and
don't show up].''
Breast exams cannot substitute for mammograms, though. ``They
are complementary to each other,'' Barton added.
The researchers, funded in part by the Harvard Pilgrim Health
Care Foundation, reviewed a total of 110 articles published from
1966 and 1997.
They found that there are five variables that affect a woman's
breast cancer exam results. They are the position the woman is
lying in during the exam, breast boundaries, the examiner's finger
position, movement, and pressure, duration of the exam and
examination search patters.
Unlike many exam instructions, which recommend examining the
breast in concentric circles moving around the breast, the
researchers found that moving in very tiny circles in an
up-and-down overlapping strips, called the ``lawn mower'' style,
covers more breast surface area.
The researchers also found that most physicians don't spend
enough time on the exam. According to the study, the average breast
exam should take a total of six minutes. In contrast, research
showed that physicians only spend about 1.8 minutes on the exam and
on giving instruction in performing a self-exam.
``My experience, and the experience of many other women, is that
the clinical breast exam is very cursory. However, this may be
changing as more emphasis is being placed on preventive medicine,''
said Nathanson.
Training and exposure to what lumps feel like may be a valuable
training tool. After receiving training on a silicone model of a
breast with lumps imbedded in it, a previous study found that women
with no medical background were able to identify almost as many
lumps as doctors could.
