What happens during a breast exam?

A breast exam is an important screening tool used to check for signs of breast cancer or other breast problems in women. During a breast exam, a doctor or nurse carefully feels the breast tissue to check for any lumps, bumps, or other abnormalities. There are a few different types of breast exams that may be performed.

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Types of breast exams

The main types of breast exams are:

Clinical breast exam – Performed by a doctor or nurse during a routine checkup. The doctor or nurse uses their hands to thoroughly examine the breasts and underarms for lumps or other changes.
Mammogram – An x-ray of the breasts. Mammograms can detect tumors or irregularities too small to be felt during a manual exam.
Breast self-exam – A woman examines her own breasts. This involves visually inspecting the look and feel of the breasts and is done monthly by women to detect changes.

What to expect during a clinical breast exam

During a clinical breast exam performed by a doctor or nurse, here is what typically happens:

The exam will likely occur in a private room with you wearing a gown.
You will be asked to raise your arms over your head as the doctor inspects your breasts visually and feels each breast using a circular motion from the outside in.

The doctor will feel for any lumps, thickening, or changes in skin texture.
With you lying down, the doctor repeats the breast exam feeling the tissue closest to the chest, then progressing outwards using vertical strip patterns.
Your doctor will squeeze each nipple gently to check for discharge.

Still in the lying down position, the doctor will feel the breast tissue under your arms on each side to check the lymph nodes there.
You’ll be asked to sit up or stand as the doctor examines the breasts again from different positions.
The doctor will finish by pressing gently on the areas between the breast and collarbone to check for any nodes or lumps.

The breast exam should not be painful, but some pressure will be applied. Let your doctor know if you feel any discomfort. A complete exam takes about 5-10 minutes for each breast.

What does the doctor look and feel for?

During the breast exam, the doctor is carefully feeling for:

Lumps or thickening: Benign cysts or malignant tumors may feel like firm or rubbery lumps. Cancerous lumps tend to be painless, hard, unevenly shaped, and can feel like they are attached to tissue.

Changes in size or shape: Subtle changes in breast size or shape could indicate an underlying problem.
Changes in skin texture: Breast skin dimpling, puckering, or redness may be warning signs.
Nipple discharge: Fluid leaking from the nipples, especially if bloody, could signal breast cancer.

Swollen lymph nodes: If lymph nodes under the arm or around the collar bone are enlarged, tender, or firm it could indicate breast cancer.

Reasons for getting a clinical breast exam

There are a few key reasons your doctor will perform breast exams as part of your routine health screenings:

Screen for breast cancer – Exams help detect breast cancer early when it is most treatable.

Establish a baseline – Initial exams establish what is normal to make it easier to identify future changes.
Screen for other problems – Exams can detect benign cysts, infections, and other issues.
recommend additional screening – If anything unusual is found, your doctor may recommend more tests like a mammogram.

How often should you get a breast exam?

Experts recommend the following breast exam frequency:

Women ages 20-39: Clinical breast exam every 1-3 years
Women 40 and older: Annual clinical breast exam and annual mammogram

Monthly self-exams starting at age 20

Your doctor may recommend more frequent exams if you have a family history of breast cancer or other risk factors. YEARLY exams are key for women over 40.

Are breast exams mandatory?

There are no laws requiring breast exams. However, leading medical groups strongly recommend regular breast cancer screening including exams and mammograms. It is considered best practice for doctors to discuss screening options with patients. Most insurance plans also fully cover annual exams and mammograms as preventive care starting at age 40.

What is a breast ultrasound?

A breast ultrasound is an imaging test that may be performed if something unusual is found during a breast exam. It uses sound waves to create detailed images of the breast tissue. Ultrasounds help differentiate between fluid-filled cysts and solid masses and can help characterize any abnormalities found on exam or mammogram. The ultrasound device is rubbed over the skin of the breast to get views from different angles.

When are breast ultrasounds recommended?

Reasons your doctor may order a breast ultrasound include:

Further evaluate a lump found on exam

Determine if breast thickening is due to a cyst
Assess abnormal nipple discharge
Guide needle placement for a breast biopsy

Further examine an abnormality seen on a mammogram
Screen high-risk women with dense breast tissue

Ultrasounds are widely used since they are painless and do not expose you to radiation like mammograms. They provide helpful information to supplement manual exams and mammography.

What happens if an abnormality is found?

If your doctor detects any sort of abnormality during your breast exam, they will determine next steps based on factors like your symptoms, breast cancer risk, and exam/imaging findings. Here’s what to expect if an abnormality is found:

More frequent breast exams – Your doctor will likely recommend follow-up exams in 4-6 weeks to see if any changes occur.
Diagnostic mammogram – Special mammogram images will be taken to further evaluate any areas of concern.

Breast ultrasound – This safe, non-invasive test provides additional evaluation of abnormal findings.
Breast biopsy – A minor surgical procedure to collect tissue samples that are examined under a microscope to check for cancer cells.

In most cases, breast abnormalities end up being non-cancerous things like cysts or fibroadenomas. But your doctor will take the necessary steps to determine if breast cancer is present and recommend the best treatment options.

Can breast exams miss breast cancer?

Yes, it is possible for breast exams to miss some early breast cancers. Some limitations include:

Small tumors can be difficult to feel by hand, especially in women with dense breast tissue.
Exams only evaluate the breast at one point in time – cancers can develop later.

Doctor error – Some areas can be missed if the exam is not performed thoroughly.
Patient factors – Current infections or recent procedures can make abnormal tissue difficult to identify.

This is why exams should be done on a regular basis and combined with imaging like mammography based on individual breast cancer risks.

How to prepare for a clinical breast exam

To get the most accurate results from your breast exam, here are some tips on how to prepare:

Schedule exam for mid-cycle – Breasts are less tender/swollen during this phase of your menstrual cycle.
Don’t apply lotions/powders – Products can mask potential problems or interfere with the exam.

List symptoms and changes – Tell your doctor about any new breast changes you’ve noticed.
Be aware of family history – Let your doctor know if any close relatives have had breast cancer.
Don’t schedule around periods – Exams can safely be performed during menstruation if needed.

Being prepared helps the exam go smoothly and maximizes the chances of detecting any issues early.

Breast self-exams: what to look and feel for

In addition to clinical exams, women should perform monthly breast self-exams. These exams involve looking at and feeling your breasts for anything unusual. When doing a self-exam, here’s what to check for:

Visible changes in size, shape, or contour – Does one breast appear differently sized or swollen?

Changes in skin texture – Dimpling, puckering, scaliness, or new visible veins.
Rash or skin irritation
Nipple changes – Nipple retraction, scaliness, itching, or spontaneous discharge.

Lumps, knots, or thickening – Pay special attention to the upper outer portions of the breast.
Pain, tenderness, or swelling – Check entire breast and up into the armpit area.

Report any new or unusual findings to your doctor promptly. Being familiar with your breast’s normal look and feel will help you detect meaningful changes.

How to perform a breast self-exam

Breast self-exams involve looking at your breasts and feeling them in a systematic step-by-step way. Follow these tips for performing thorough self-exams:

Conduct exam 1 week after period ends when breasts are less tender.
Visually inspect breasts in the mirror – hands on hips, then overhead.

Feel each breast while lying down – use right hand for left breast and vice versa.
Check the entire breast area – follow an up and down pattern moving from underarm to center.
Use palm, fingers flat, and in circles for texture check – press firmly but gently.

Squeeze each nipple to look for discharge.
Repeat visual inspection and feel with arms overhead while standing.
Finish by checking lymph nodes above the collarbones and under each arm.

If you notice anything abnormal during your self-exam, follow-up promptly with your healthcare provider. Detecting issues early greatly improves treatment success.

What does it mean if a lump is found during self-exam?

Finding a new lump or mass in your breast during a self-exam can be alarming. Fortunately, the majority of breast lumps are non-cancerous (benign). Common causes include:

Cysts – Fluid-filled sacs that are movable and oval-shaped.

Fibroadenomas – Solid, round, rubbery masses that are painless.
Lipoma – Fatty non-cancerous tumor.
Abscess – Localized pus-filled mass caused by infection.

However, any new breast lump warrants medical evaluation. Make an appointment promptly for an exam by your doctor. They will determine if imaging tests or biopsy are needed to analyze the lump.

Are breast exams necessary if you get regular mammograms?

Yes, breast exams remain an essential screening tool even for women who get routine mammograms. Here’s why:

Exams find some cancers not seen on mammograms – Palpation detects tumors mammograms may miss.

Exams can detect cancer between screening mammograms.
Doctors can assess symptoms like nipple discharge or skin changes.
Allows women’s questions and concerns to be addressed during appointment.

Opportunity for doctor to recommend additional testing like ultrasound, MRI, or biopsy.

The combination of exams, self-exams, and mammography provides the best monitoring to detect breast abnormalities at the earliest stage.

Key takeaways

Clinical breast exams should be done every 1-3 years for women in their 20s/30s and annually after age 40.

Exams allow doctors to feel for warning signs of cancer like lumps, skin changes, or enlarged lymph nodes.
Breast ultrasounds may be used for further evaluation when an abnormality is found.
Self-exams supplement clinical exams and help women become familiar with their breasts.

Finding a lump during self-exam requires prompt medical evaluation, though most lumps are benign.
Breast exams remain essential even with routine mammograms to maximize early detection.