Which scientific rationale should the nurse remember when performing a breast examination on a female client?

The American Cancer Society recommends beginning in their 20s, women should be told about the benefits and limitations of BSE. Women should be aware of how their breasts normally look and feel and should report any breast changes to a health professional as soon as they are found. Finding a breast change does not mean there is a cancer. Women can notice changes by being aware of how their breasts normally look and feel and by feeling their breasts for changes (breast awareness) or by choosing to use a step-by-step approach, using a specific schedule to examine her breasts (breast-self exam, or BSE)

Examining your breasts is an important way to find a breast cancer early, when it’s most likely to be cured. Not every cancer can be found this way, but it is a critical step you can and should take for yourself. No woman wants to do a breast self exam (or “BSE”), and for many the experience is frustrating-you may feel things but not know what they mean. However, the more you examine your breasts, the more you will learn about them and the easier it will become for you to tell if something unusual has occurred. BSE is an essential part of taking care of yourself and reducing your risk of breast cancer.

Regularly examining her own breasts allows a woman to become familiar with how her breasts normally look and feel and can help her more readily detect any changes that may occur. Many women naturally have some lumpiness and asymmetry (differences between the right and left breast). The key to the breast self-exam is to learn how to find changes in the breasts that persist over time. While most women are aware of monthly breast self-examination, many still do not know how to perform it properly. Performing BSE incorrectly can be almost as bad as not doing the exam at all since it can give women a false sense of security. Don’t panic if you think you feel a lump. Most women have some lumps or lumpy areas in their breasts all the time. Eight out of ten breast lumps that are removed are benign, non-cancerous.

Breast self-exams should be performed once each month beginning at age 20 and continue each month throughout a woman’s lifetime.

The Best Time to Perform Breast Self-Exam

Menstruating Women:

Hormonal changes due to the menstrual cycle may make the breasts more lumpy or swollen. Women who are menstruating should perform breast self-exam from a few days to about a week after menstruation (period) has ended, when breasts are usually less tender or swollen.

Women who are no longer menstruating:

They should do their BSE on the same day every month. Try to pick a day that is easy to remember, such as the first or fifteenth of every month, and make that the day each month for breast self-exam.

Women using oral contraceptives:

They are encouraged to do their BSE each month on the day they begin a new package of pills.

Step 1:
Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.

Here’s what you should look for: • Breasts that are their usual size, shape, and colour.

• Breasts that are evenly shaped without visible distortion or swelling.

If you see any of the following changes, bring them to your doctor’s attention: • nipple discharge • dimpling, puckering, or bulging of the skin. • a nipple that has changed position or an inverted nipple (pushed inward instead of sticking out).

• Redness, soreness, rash, or swelling.

Step 2:
Now, raise your arms and look for the same changes.

Step 3:
While looking at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge (this could be a milky or yellow fluid or blood).

Step 4: • Lie down and place your right arm behind your head. The exam is done while lying down, and not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and it is as thin as possible, making it much easier to feel all the breast tissue. • Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Use overlapping circular motions of the finger pads to feel the breast tissue. • Be sure to feel all the breast tissue: just beneath your skin with a soft touch and down deeper with a firmer touch. Begin examining each area with a very soft touch, and then increase pressure so that you can feel the deeper tissue, down to your ribcage.

• Repeat the exam on your left breast, using the finger pads of the right hand.

Step 5:
Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it difficult to examine.

Despite the advances in breast imaging, there are clear indications for the need of clinical breast examination as part of breast cancer screening for all women. The article reviews the technique for clinical breast examination and assessment of its results. The main goal of the clinical breast examination is to differentiate normal physiologic nodularity from a discrete breast mass. If a discrete mass is identified, evaluation is mandatory in all cases to exclude breast cancer. This evaluation is guided by the features of the clinical findings, the age of the woman, and her personal risk for breast cancer.

The rapid expansion of new technologies in screening and early detection of breast cancer would seem to diminish the value of clinical breast examination. Certainly, we have improved technology and demonstrated the benefits of mammography in early breast cancer detection,[1,2,3,4,5,6] and new technologies, including computed tomography and magnetic resonance imaging, are in development.[7] New markers for mutations in the BRCA1 and BRCA2 genes have enabled stratification of certain high-risk women.[8] Despite these advances, there continues to be a real need for expertise in clinical breast examination. This article will outline the rationale for this need and review the data on the technique of clinical breast examination and the management of women with abnormal clinical findings.

Despite the improvements in technology, early detection of breast cancer is not always straightforward. Mammography at its best has a sensitivity of about 85% to 90% in women older than 50 years of age; for women between the ages of 40 and 50, sensitivity is about 75% and is probably lower in women younger than age 40.[9] This means that mammography will miss 1 in every 4 breast cancers in women between the ages of 40 and 50. Clinical breast examination is required to address these gaps in screening sensitivity.

Second, false-positive results can occur with mammography. That is, an abnormality found on screening examination may later be determined to be either an artifact of the technique or a benign finding. With annual screening over 10 years, the chances of a false-positive result, depending on the lesion and a woman's risk, may be over 50%.[10] Given the controversy around the efficacy of mammography before age 50 and this high potential for a false-positive result, some patients, and some providers, are electing to wait to begin mammography screening until the patient is 50 years old.[11] This underscores the need for clinical breast examination.

Skill in conducting and interpreting clinical breast examination findings is essential, especially in the context of a mammogram without abnormalities. The most common reason for litigation for failure to diagnose breast cancer occurs in the setting of a young woman with a finding on clinical or self breast examination and a negative mammogram.[12] Most practicing physicians, when surveyed, acknowledge a need to increase their competence in clinical breast examination.[13]

Lastly, with the increasing use of mammography, there is evidence that providers are more likely to omit the clinical breast examination, perhaps because they believe that the mammographic examination is sufficient.[14,15] In addition, some studies have shown that rates of clinical breast examination decrease with patient age, as a woman's risk increases.[16]

Physicians trained in internal medicine and family medicine perform clinical breast examination at lower rates than gynecologists,[17] although most women older than age 40 seek their primary care from providers within these 2 specialties. These data underscore the need for these providers to conduct clinical breast examinations in their female patients.

© 2000  Medscape

Cite this: Rationale and Technique of Clinical Breast Examination - Medscape - Nov 14, 2000.

10 Questions | Total Attempts: 5079

• Which assessment data should the nurse include when obtaining a review of body systems

  • Brief statement about what brought the client to the health care provider

  • Client complaints of chest pain. dyspnea. or abdominal pain

  • Information about the client’s sexual performance and preference

  • The client’s name. address. age. and phone number

• Tywin has come to the nursing clinic for a comprehensive health assessment. Which statement would be the best way to end the history interview?

  • “What brought you to the clinic today?”

  • “Would you describe your overall health as good?”

  • “Do you understand what is happening?”

  • “Is there anything else you would like to tell me?”

• For which time period would the nurse notify the health care provider that the client had no bowel sounds?

• Evaluating the apical pulse is the most reliable noninvasive way to assess cardiac function. Which is the best area for auscultating the apical pulse?

• Beginning in their 20s. women should be told about the benefits and limitations of breast self-exam (BSE). Which scientific rationale should the nurse remember when performing a breast examination on a female client?

  • One half of all breast cancer deaths occur in women ages 35 to 45

  • The tail of Spence area must be included in self-examination

  • The position of choice for the breast examination is supine

  • A pad should be placed under the opposite scapula of the breast being palpated

• Mr. Lim. who has chronic pain. loss of self-esteem. no job. and bodily disfigurement from severe burns over the trunk and arms. is admitted to a pain center. Which evaluation criteria would indicate the client’s successful rehabilitation?

  • The client remains free of the aftermath phase of the pain experience.

  • The client experiences decreased frequency of acute pain episodes.

  • The client continues normal growth and development with intact support systems.

  • The client develops increased tolerance for severe pain in the future.

• Christine Ann is about to take her NCLEX examination next week and is currently reviewing the concept of pain. Which scientific rationale would indicate that she understands the topic?

  • Pain is an objective sign of a more serious problem

  • Pain sensation is affected by a client’s anticipation of pain

  • Intractable pain may be relieved by treatment

  • Psychological factors rarely contribute to a client’s pain perception

• Miggy. a 6-year-old boy. received a small paper cut on his finger. his mother let him wash it and apply small amount of antibacterial ointment and bandage. Then she let him watch TV and eat an apple. This is an example of which type of pain intervention?

• Which statement represents the best rationale for using noninvasive and non-pharmacologic pain-control measures in conjunction with other measures?

  • These measures are more effective than analgesics.

  • These measures decrease input to large fibers.

  • These measures potentiate the effects of analgesics.

  • These measures block transmission of type C fiber impulses.

• When evaluating a client’s adaptation to pain. which behavior indicates appropriate adaptation?

  • The client distracts himself during pain episodes.

  • The client denies the existence of any pain.

  • The client reports no need for family support.

  • The client reports pain reduction with decreased activity.

• ACLS
• CEN
• CMA
• CPR
• EMT
• NCCT
• HESI