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Clinical Breast Examination: Practical Recommendations for Optimizing Performance and Reporting

Dr. Saslow is Director, Breast and Gynecological Cancers, American Cancer Society, Atlanta, GA.
Ms. Hannan is Chief, Education and Training Section, Program Services Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.
Dr. Osuch is Professor of Surgery and Epidemiology, Michigan State University, East Lansing, MI.
Dr. Alciati is President, Management Solutions for Health, Inc., Reston, VA.
Dr. Baines is Professor Emerita, Department of Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.
Dr. Barton is Assistant Professor, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA.
Dr. Bobo is Health Research Leader and Senior Epidemiologist, Battelle Centers for Public Health Research and Evaluation, Seattle, WA.
Ms. Coleman is Consultant, Breast Center Development, Tiburon, CA.
Dr. Dolan is Division Chief, Women’s Primary Healthcare, University of North Carolina School of Medicine, Chapel Hill, NC.
Ms. Gaumer is Nurse Consultant for Quality Assurance, Georgia Department of Human Resources, Savannah, GA.
Dr. Kopans is Director, Breast Imaging Division, Massachusetts General Hospital, Boston, MA.

Dr. Kutner is Chair, Breast Cancer Task Force of Northern California Kaiser Permanente, and Surgeon, Santa Teresa Medical Center, San Jose, CA.
Dr. Lane is Associate Dean, Continuing Medical Education, and Distinguished Service Professor, Vice Chair and Residency Program Director, Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY.
Dr. Lawson is Senior Medical Advisor, Program Services Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.
Dr. Meissner is Chief, Applied Cancer Screening Research Branch, National Cancer Institute, Rockville, MD.
Ms. Moorman is Chief, Professional Education Unit, Cancer Detection Section, California Department of Health Services, Sacramento, CA.
Dr. Pennypacker is Professor of Psychology, University of Florida, and President, Mammatech Corporation, Gainesville, FL.
Ms. Pierce is Assistant Professor, University of Tennessee College of Nursing, Knoxville, TN.
Ms. Sciandra is Director of Breast Health, American Cancer Society, Eastern Division, Loudonville, NY.
Dr. Smith is Director, Cancer Screening, American Cancer Society, Atlanta, GA.
Dr. Coates is Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.

Clinical breast examination (CBE) seeks to detect breast abnormalities or evaluate patient reports of symptoms to find palpable breast cancers at an earlier stage of progression. Treatment options for earlier-stage cancers are generally more numerous, include less toxic alternatives, and are usually more effective than treatments for later-stage cancers. For average-risk women aged 40 and younger, earlier detection of palpable tumors identified by CBE can lead to earlier therapy. After age 40, when mammography is recommended, CBE is regarded as an adjunct to mammography. Recent debate, however, has questioned the contributions of CBE to the detection of breast cancer in asymptomatic women and particularly to improved survival and reduced mortality rates. Clinicians remain widely divided about the level of evidence supporting CBE and their confidence in the examination. Yet, CBE is practiced extensively in the United States and continues to be recommended by many leading health organizations. It is in this context that this report provides a brief review of evidence for CBE’s role in the earlier detection of breast cancer, highlights current practice issues, and presents recommendations that, when implemented, could contribute to greater standardization of the practice and reporting of CBE. These recommendations may also lead to improved evidence of the nature and extent of CBE’s contribution to the earlier detection of breast cancer.

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