1. CLINICAL BREAST EXAMINATION
Assist.Prof. Arzu Akalın M.D.

2. CLINICAL BREAST EXAM includes; careful history-taking,
visual inspection,
palpation of
both breasts,
armpits and
root of the neck
educating women on breast self-examination and awareness, particularly on breast lumps.

3. Risk Factors
A familial history of breast cancer increases the risk by a factor of two or three.
Some mutations, particularly in BRCA1, BRCA2 and p53 result in a very high risk for breast cancer.
Prolonged exposure to endogenous estrogens, such as early menarche, late menopause, late age at first childbirth
Oral contraceptive and hormone replacement therapy use
Alcohol use,
Overweight and obesity,
Physical inactivity
Breastfeeding has a protective effect

4. HISTORY TAKING age at menarche, marital status, parity,
age at first child birth,
history of lactation and breast-feeding,
age at menopause,
family history of breast and ovarian cancers in first degree relatives (mother, sisters, aunts, grandmothers),
history and duration of oral contraceptive use, hormone replacement therapy (HRT), treatment for infertility
tobacco and alcohol use.

5. Breast Anatomy

6. Breast Anatomy The breast is composed of 15-20 lobes and contains
glandular,
ductal,
fibrous, and
fatty tissue.

7. More lobes are present in the outer quadrants, especially the upper outer quadrants,
Therefore many breast conditions (among them, breast cancer) occur more frequently in these regions

8. Axillary tail of breast tissue
An axillary tail of breast tissue extends toward the anterior axillary fold.

9. Examination of the Breast (Inspection & Palpation)
The exam should be performed in a well-lit room and privacy is facilitated by draping parts of the body not being examined.

10. Examination of the Breast (Inspection & Palpation)
Occurs with the patient seated,
Arms at side;
With hands on hips; and
With arms above the head.
Changes in size, shape, symmetry, or texture are noted.

11. INSPECTION

15. Examination of the Breast (Inspection & Palpation)
Is performed with the
patient supine,
arms flexed at a 90-degree angle at the sides.
Palpation includes supraclavicular, infraclavicular, and axillary nodes.
Compression may identify a mass and/or elicit a discharge.
Nipples should be examined for deviation, retraction, skin changes, or discharge.

16. Supraclavicular L N
Infraclavicular LN
Axillar LN
Internal Mammary LN

20. Benign Breast Masses General Considerations
Benign breast masses will often change with the menstrual cycle, while worrisome masses are persistent throughout.
Greater than 90% of palpable breast masses in women between 20 and 55 are benign.
Masses may be discrete or poorly defined, but differ from the surrounding breast tissue and the corresponding area in the contralateral breast.
Cancer should be excluded in a woman who presents with a solid mass.

21. Benign Breast Masses Breast cysts Fibrocystic breast changes
Fibroadenoma
Ductal papilloma

22. Nipple Discharge Categorized as Physiologic
Pathologic (nonphysiologic).
Physiologic
Pathologic
Nonspontaneous
Spontaneous
Bilateral
Unilateral
Arising from multiple ducts
Arise from a single duct

23. Carcinoma of the Breast
Most common malignant tumor among women
1/8 of women will develop breast cancer

25. Physical Signs a. Slowly growing, painless mass
b. May demonstrate retracted nipple
c. May be bleeding from nipple
d. May be distorted areola, or breast contour
e. Skin dimpling* in more advanced stages with
retraction of Cooper’s ligaments
*Dimple=Gamze
Note skin dimpling in the 6 o'clock radius

26. f. Attachment of mass
g. Edema of skin
1)with “orange skin” appearance (peau d’orange) due to blocked lymphatics
h. Enlarged axillary or deep cervical lymph nodes

27. Breast Cancer Screening Guidelines of ACS* 2012
BSE ages ≥20 monthly or irregular
CBE ages part of periodic examination at least every 3 year
ages ≥40 annually
Mammography begin anuual mammography at age 40
* American Cancer Society