The Need for Performance and Standardization of the Best Clinical Breast Exam

Breast cancer is the most frequently diagnosed cancer in women. Mammography is not perfect; on average, it will detect about 80% to 90% of breast cancers in women without symptoms. Clinical breast exam (CBE) is widely used in this country, although controversy about this technique exists, and studies largely do not support CBE. The American Cancer Society (ACS), in collaboration with the Centers for Disease Control and Prevention (CDC), developed a committee in 2002 to provide standards and recommendations for physicians and health organizations to enhance CBE performance and reporting. They also recommended the vertical strip method for CBE and development of a system of reporting utilizing the Breast Imaging Reporting and Data System and its lexicon developed by the American College of Radiology. CBE sensitivity has been shown to improve with training, use of silicone models, and live breast models to provide feedback. The MammaCare technique has been shown to increase sensitivity in performing CBE; however, many practitioners are still using the older concentric circle, or radial spokes method. This article presents the best-evidence-based method of CBE and also presents a good argument for standardization of CBE methodology.