Clinical Breast Exam

A clinical breast examination is done by a health professional. You will need to take off your clothes above the waist. You will be given a gown to wear during the examination.

First, your health professional will ask you questions about any problems you may have, your medical history, and your risk factors for breast cancer. Talk to your health professional about any areas of your breasts you may be concerned about. Your health professional will then examine each breast, underarm, and collarbone area for changes in breast size, skin changes, or signs of injury or infection, such as bruising or redness. You may be asked to lift your arms over your head, put your hands on your hips, or lean forward and press your hands together to tighten the muscle beneath each breast during this part of the examination. You may also lie flat on the table and put your arm behind your head while your health professional checks your breast tissue.

Your health professional will feel (palpate) each breast for any unusual or painful areas or for a dominant lump. A dominant lump in the breast is any lump that is new, larger, harder or different in any other way from other lumps or the rest of the breast tissue.

Your health professional will gently press on the breast tissue from about 1 in. (2.5 cm) below the breast up to the collarbone. He or she also will examine your armpit (axillary area) and your neck for swollen glands (lymph nodes). Your health professional will likely press gently on your nipple to check for any discharge. After the examination, your health professional may teach you how to examine your own breasts (breast self-examination) and help you practice doing it.

Reasons you may not be able to have the test or why the results may not be helpful include:

• Your menstrual cycle. The changes in your body that occur during your menstrual cycle may make your breast tissue feel or look different.
• Having fibrocystic lumps. Fibrocystic lumps make a clinical breast examination hard to do because many lumps are present in the breast.

Findings of a clinical breast examination may include the following.

Normal

• The nipples, breast tissue, and areas around the breast look normal and are normal in size and shape. One breast may be slightly larger than the other.
• A small area of firm tissue may be present in the lower curve of the breast below the nipple.
• Tenderness or lumpiness that occurs in both breasts is normal for many women. Many women have the same lumpiness or thickening in both breasts during the menstrual cycle.
• A clear or milky discharge (galactorrhea) may be present when the nipple is squeezed. This may be caused by nursing, breast stimulation, hormones, or some other normal cause.
• One breast may have more glandular tissue (lumps) than the other one, especially in the upper outer quadrant of the breast.

Abnormal

• A firm lump or area of thickening may be present in one of your breasts.
• Changes in the color or feel of your breast or nipple may be present. This can include wrinkling, dimpling, thickening, or puckering or an area that feels grainy, stringy, or thickened.
• A nipple may sink into the breast. A red, scaly rash or sore may be found on the nipple.
• Redness or warmth over a painful lump or over an entire breast may be present. This may be caused by an infection (abscess or mastitis) or cancer.
• A bloody or milky discharge (galactorrhea) may occur without stimulation (spontaneous nipple discharge).

A normal clinical breast examination does not mean that breast cancer is not present. Depending on your age and your personal and family history of breast cancer, your health professional may do other tests, such as a mammogram.

If a breast problem is found, the next step depends on the problem.

• Cyclic breast pain, fibrocystic changes, or cysts may just be rechecked to see if they change or go away on their own. Cysts may also be checked by ultrasound or drained with a needle (aspirated) to make sure they are cysts and to help relieve pain.
• A mammogram, magnetic resonance imaging (MRI), or ultrasound may be needed if a lump is found. Breast tissue may be taken out with a needle (needle aspiration or core biopsy) or through a small cut (biopsy) to be looked at under the microscope.
• Nipple discharge, especially if it is spontaneous or bloody, may be looked at under a microscope for unusual cells.

A clinical breast examination normally does not cause any discomfort unless your breasts are tender.

Tell your health professional if you:

• Have a new lump or change in your breasts. This includes a change in the way your nipples look or if you have any nipple discharge.
• Some women have nipples that sink into the breast, called inverted nipples. For these women, this is normal. But if you do not have inverted nipples and notice a change where your nipple becomes inverted, tell your doctor.
• Have pain in one breast, especially if the pain is not related to having your menstrual period.
• Are or might be pregnant.
• Are breastfeeding.
• Have breast implants.
• Have had a breast biopsy.
• Have completed menopause.
• Are taking hormone therapy.
• Have a personal or family history of breast cancer.

You may want to have your examination 1 to 2 weeks after your menstrual period ends, if you are still menstruating; your breasts are less likely to be tender at that time.

Talk to your health professional about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean.