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Clinical breast examination - Is it so important?

A report in the BMJ by Dr Des Spence is very thought provoking.

In some countries examining the breast is promoted to screen for breast cancer (American Cancer Society). There is no evidence that Doctor based screening and teaching self-examination reduces breast cancer death rates but they may cause harm by anxiety and over investigation.

Examining the breast in ladies for screening and ladies with no lumps is of no use. The best way of screening ladies without lumps is routine mammography and all women should be ‘breast aware’.

For women who notice a breast lump NICE (National Institute for Clinical Excellence) recommend they should be referred to a centre that can undertake needle aspiration, mammography ultrasound, MRI and biopsy.

Clinical examination has limited diagnostic accuracy or impact on management except in young patients. For GP’s clinical examination of the breasts is becoming less important and perhaps using a cheap portable ultrasound to examine the breast would be of more value.