During a clinical breast exam, a healthcare professional inspects the breasts by looking and feeling for any changes or abnormalities. Clinical breast exams are usually done during an annual physical exam on women who are having no symptoms as a screening test. However, a clinical breast exam may be performed on a woman or a man who is having symptoms that may be caused by breast cancer.1
The anatomy of the breast tissue
The breast contains milk glands, milk ducts, fat, and connective tissue. The breast area extends from just under the collarbone (also known as the clavicle) to the bra line, or inframammary crease. On the sides, it goes from the sternum to the underarm area, and because there are a cluster of lymph nodes in the underarm, called the axillary lymph nodes, the exam will typically include this area.1
Visual inspection
Your healthcare professional will look at the breast tissue to assess the size and shape of the breasts as well as the appearance of the skin on the breast. Any differences in size or shape will be noted. (Most women have one breast that is slightly larger than the other, but any changes in size or shape from what is normal should be brought to the attention of your doctor.) The skin will be inspected for any rashes, redness, scaly or flaky skin, dimpling, puckering, or swelling. One rare type of breast cancer can make the breast skin appear like an orange skin (this appearance is known as peau d’orange). The doctor will also examine the nipple for any abnormalities, such as an inverted nipple (nipple turning inwards) or discharge from the nipple.1,2
The doctor or healthcare professional may also have you move in different positions, such as sitting up or standing, hands on hips, and/or laying down. This enables them to see the breasts in different positions and can help observation of any potential abnormalities.1,2
Palpation
Palpation, or touch, is used to feel for any abnormalities in the breast, such as a lump, thickening, or swollen lymph node. Your healthcare professional will typically use the pads of their middle three fingers to press on the breast tissue from the collarbone to the bra line, and from the sternum to the underarm. You may feel different pressures as the doctor assesses different layers of the breast tissue.1
While breasts normally have a lumpy consistency, the doctor will feel for any abnormal, hard lumps that are immovable or feel stuck to other tissue. Lumps that are benign (non-cancerous) generally feel movable and more regular, while cancerous lumps can feel irregular and immovable. However, any suspicious lump will need further evaluation to determine if it is cancerous (malignant) or not.1,2
Additional follow-up
If your doctor finds an abnormality, they may suggest one or more additional tests, including:
- Mammogram – an x-ray of the breast while it is compressed between two plates
- Ultrasound – a scanning technique that uses sound waves and is helpful in determining if a lump is fluid-filled (like a cyst) or solid
- Biopsy – a technique which extracts a sample of the lump to examine under a microscope
