Guidelines

Breast Examination

The College has received many complaints about breast examinations that are perceived as inappropriate by the patients. Some common causes of complaint are avoidable.

'Examining' the breasts under or through clothing is perceived either as cursory in nature or to have a sexual intent. If the breasts are to be examined, the examination must consist of inspection and careful palpation of all the breast tissue and palpation of the lymphatic drainage areas in the axilla and supraclavicular regions. This can only be done with the patient disrobed. Proper gowns and/or drapes must be provided.

Not explaining the reason for the breast examination and not explaining findings. For instance, an orthopaedic surgeon, who is seeing a female patient for back pain, might want to exclude metastatic breast cancer as a cause. An uninformed patient would not know of the possible connection and might misinterpret the surgeon's intent.

Squeezing or tweaking the nipples to look for discharge is often perceived by the patient as sexual. Since the only discharge from the nipple that has clinical importance is a spontaneous discharge, it is recommended that doctors do not squeeze the nipple in an examination. If the patient complains of a discharge from the nipple, the doctor can ask her to express the nipple herself to demonstrate the discharge.

Unusual or outdated examination techniques, such as examining the breasts while standing behind the patient, using both hands at once, or examining both breasts at once, will arouse a patient's suspicions.

The breasts should be examined from the front, using the flat of the fingers to palpate the breast tissue against the underlying rib-cage. The tissue should be examined in a systematic pattern. The tissue should be moved against the chest wall so that a cartilage or a rib is not mistaken for a breast lump. The patient should be examined in both the sitting and lying positions.

The patient should be informed of findings - for instance, "Everything is normal."

Whenever possible, a breast examination should be used as an opportunity to teach or reinforce breast self-examination.

(From the College of Physicians and Surgeons of British Columbia)

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© College of Physicans and Surgeons of New Brunswick