Clinical Breast Examination: Practical Recommendations for Optimizing Performance and Reporting

Saslow, Debbie; Hannan, Judy; Osuch, Janet; Alciati, Marianne Haenlein; Baines, Cornelia J.; Barton, Mary B.; Bobo, Janet Kay; Coleman, Cathy; Dolan, Mary Segars; Gaumer, Ginny; Kopans, Daniel B.; Kutner, Susan E.; Lane, Dorothy S.; Lawson, Herschel W.; Meissner, Helen I.; Moorman, Candace; Pennypacker, H. S.; Pierce, Peggy; Sciandra, Eva; Smith, Robert A.; Coates, Ralph J.

doi:10.3322/canjclin.54.6.327

Cited by 138 publications

(113 citation statements)

References 28 publications

Supporting

Mentioning

110

Contrasting

Unclassified

Order By: Relevance

“…Data support the performance of cbe using the vertical strip method instead of the circular ("clock") pattern 44,45 . In addition, the use of 3 fingers, of 3 distinct pressure levels, of a visual examination of the breast, and of an axillary examination should be encouraged 46 .…”

Section: Figurementioning

confidence: 99%

Is Clinical Breast Examination Important for Breast Cancer Detection?

et al. 2016

View full text Add to dashboard Cite

show abstract

Section: Figurementioning

confidence: 99%

Is Clinical Breast Examination Important for Breast Cancer Detection?

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The best coverage of breast tissue occurs by examining the breast in vertical strips beginning at the axilla and extending down the mid-axillary line to the bra line, then moving medially in rows to the center of the chest. 22 Ideal educational modalities include simulation training along with exposure to patients. Trainees that participated in a structured CBE curriculum (including didactic, simulation practice and standardized patients) were more proficient at identifying abnormal breast findings in silicone models than those that did not receive training.…”

mentioning

confidence: 99%

The Clinical Breast Exam: A Skill that Should Not Be Abandoned

Bryan

Snyder

2013

J GEN INTERN MED

View full text Add to dashboard Cite

The clinical breast exam (CBE) is an important tool in the care of women. However, the utility of the screening CBE has been called into question. This article discusses the importance of the CBE as a physical diagnosis tool. Recommendations regarding screening with CBE are reviewed, and evidence surrounding breast cancer screening using CBE is briefly summarized. Clinicians should strive to provide high quality CBEs as part of the general clinical exam for women, particularly those who present with breast complaints, and for patients who choose to have CBE screening. In conclusion, there is a role for the CBE in the care of women, and clinicians should be proficient at performing these exams. Simulation teaching technologies are now available at Department of Veteran Affairs (VA) facilities to enable clinicians to improve their CBE skills. T he clinical breast exam (CBE) is an important tool in the care of women. It is utilized for the evaluation of breast complaints and, more controversially, in breast cancer screening. The Department of Veteran Affairs (VA) Women's Health Services Office has recently coordinated the distribution of breast exam simulation equipment to VA facilities in order to enhance CBE competency training for VA providers. Since the utility of the screening CBE has been called into question, 1 the issue may be raised as to whether this training is pertinent. The following summary will provide rationale that the CBE is an important physical diagnosis skill that should not be discarded, and that simulation equipment is a helpful tool in training clinicians.Clearly, the CBE is required for the evaluation of patients with breast complaints, particularly those with a breast lump. In one study of primary care clinics, 11 % of women complaining of a breast lump and 4 % of women with any breast complaint were found to have a malignancy. 2 In addition, a significant number of patients with breast cancer present with a palpable breast mass. Haakinson et al. 3 reported that 34 % of women with invasive breast cancer initially presented with a palpable lesion. 13 % of the women with a palpable breast mass who were found to have invasive cancer had a normal mammogram within the previous year. Likewise, a large study of diagnostic mammograms reported that the sensitivity of mammography in women with a self-reported breast lump was 87.3 %. 4 This suggests that approximately 13 % of clinically evident breast cancers may be missed by mammography imaging. Therefore, identifying these tumors by palpation is a pertinent clinical issue, and providers should be proficient at discerning abnormal breast findings.The more divisive issue is whether the clinical breast exam should be used in conjunction with mammography for breast cancer screening in asymptomatic patients. The US Preventive Services Task Force (USPSTF) states that there is insufficient evidence to recommend for or against routine screening with the CBE. 1 However, the American Cancer Society 5 and the American College of Obstetricians and Gynecologist...

show abstract

“…The evidence to support the benefit of breast examination in terms of reducing breast cancer morbidity and mortality via early breast cancer detection is not well established (Saslow et al, 2004). Clinical Breast Examination (CBE) is extensively practiced in countries like the United States and is considered part of the regular health exam every 3 years in the third and fourth decades of a woman's life and every year as of the fifth decade (Saslow et al, 2004). In addition, CBE remains a basic required skill for physicians in training and offers health-care providers the capacity to educate women on breast health.…”

Section: Introductionmentioning

confidence: 99%

Hybrid Simulation in Teaching Clinical Breast Examination

Nassif¹,

Sleiman²,

Nassar³

et al. 2016

MedEdPublish

View full text Add to dashboard Cite

Problem: Clinical Breast Examination (CBE) is traditionally taught to third year medical students using a lecture and a table-top breast model. The opportunity to clinically practice CBE depends on patient availability and willingness to be examined by students, especially in culturally sensitive environments. Intervention:We employed hybrid simulation of the breast and aimed to investigate its effectiveness as an educational tool for teaching CBE to medical students. The hybrid simulation model consists of a standardized patient (SP) wearing a silicone breast simulator jacket. Context:We compared the use of this tool to the traditional method using a blinded randomized controlled design. Medical students (N=82, 48.8% male) were randomized into teaching activities: hybrid simulation and control. Both groups received didactic teaching followed by a practical session. The control group practiced on the table-top model traditionally used while the intervention group practiced on the hybrid model (SP+breast jacket). Next, all students were assessed on their technical and communication skills in an Objective Structured Clinical Examination (OSCE) that included three SP stations. SPs were trained to act according to specified cultural roles: a liberal woman, a veiled woman and a moderately modest woman. Assessment employed a variety of simulated lesions. Outcomes:The hypothesized outcomes consisted of a more complete acquisition of CBE skills, improved lesion detection and better communication skills. CBE completeness scores did not differ between the two groups (p=0.889). Hybrid simulation improved lesion identification grades (p<0.001) without increasing false positives. Communication skills were worse in the hybrid simulation group as graded by the SP (p<0.001), but not as reported by the students (p=0.346). We commented on the students' comfort during OSCE. Hybrid simulation relieved the fear of missing a lesion on CBE (p=0.043) and increased satisfaction with the teaching method among students (p=0.002).Lessons Learned: As a novel educational tool, hybrid simulation improves the sensitivity of CBE done by medical Nassif J, Sleiman A, Nassar A, Naamani S, Sharara-Chami R MedEdPublish https://doi.org/10. 15694/mep.2016.000115 Page | 2 students without affecting its specificity. Although it might not necessarily improve their communication or sensitivity to cultural aspects of CBE, hybrid simulation might have a role in increasing the self-confidence of medical students during CBE.

show abstract

Clinical Breast Examination: Practical Recommendations for Optimizing Performance and Reporting

Cited by 138 publications

References 28 publications

Is Clinical Breast Examination Important for Breast Cancer Detection?

Is Clinical Breast Examination Important for Breast Cancer Detection?

The Clinical Breast Exam: A Skill that Should Not Be Abandoned

Hybrid Simulation in Teaching Clinical Breast Examination

Contact Info

Product

Resources

About