Clinical breast examination for asymptomatic women - exploring the evidence.

BACKGROUND

Clinical breast examination (CBE) is often offered as a component of the well woman check or carried out at the request of an asymptomatic woman. In these cases the examination is a screening procedure, as opposed to a diagnostic CBE in a symptomatic woman.

OBJECTIVE

This article examines the evidence for screening CBE.

DISCUSSION: Screening CBE should involve informed consent. A negative examination does not exclude the presence of breast cancer and women should be aware of this. There have been no randomised controlled trials of CBE alone, only trials comparing CBE with mammography for the detection of breast cancer. While there is a low sensitivity (54%) for CBE, the specificity is high (94%). It is unlikely that these figures are discussed with patients. There are different methods of CBE, and these are described in the literature without a firm evidence base as to effectiveness. However, evidence does suggest that practice on models and retraining help improve clinicians' skills.