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Question 2: When is the ideal time to complete a clinical breast exam? What steps would you follow for concerning findings on the clinical breast exam? What age or risk factors indicate the need for a mammogram?
Clinical breast exams are normally done during a woman’s annual vaginal exam. Normally performed by a healthcare provider with proper training. The National Comprehensive Cancer Network recommends that a trained provider carefully feel the breast, underarm and the breast bone area for any concerns such as a lump. Clinical breast exams should be performed every one to three years starting at the age of 20 and every year starting at the age of 40 (Susan G. Komen Staff, 2018).
The American Cancer Society does not recommend CBE for screening of breast cancer. Clinical breast examinations lack the evidence to be an effective screening for breast cancer according to The American Academy of Family Physician’s. The clinical breast exam is a time burden for clinicians, rather it is recommended that more time is spent on the comprehensive assessment of family history and counseling on mammograms and breast changes (Bredemeyer, 2016).
If there are abnormal findings during the CBE, it is important to follow with a mammogram or breast ultrasound to identify the concern, if there is a long family history and/or the patient is over 30 years of age. If the patient is under thirty with no family history the physician may decide to watch the area for growth or pain. Normally that time frame is approximately one or two menstrual periods. Once the concern is located, and deemed a true concern, biopsy and further testing will be needed. It is important to note that most abnormal findings are found to be benign, however it is vital to pay close attention to changes in the area of concern and work with the physician to determine course (Bredemeyer, 2016).
When a patient has a lengthy family history of cancer, either breast or other cancer, yearly mammograms are necessary to determine concerns early. In recent years there is also Breast magnetic resonance imaging (MRI) that gives a three dimensional look of the breast, this test can also be used after a positive mammogram comes back (Susan G. Komen Staff, 2018).
It is important to note that if there is a positive screen for breast cancer, it is important to receive a second opinion to ensure that it is not a false positive. Normally a biopsy will be done to ensure the pathology. References
Bredemeyer, M. (2016). ACS Releases Guideline on Breast Cancer Screening. American Family Physician, 711-712.
Susan G. Komen Staff. (2018, July 6). Clinical Breast Exam. Retrieved from Susan G. Komen: ww5.komen.org/breastcaner/clinicalbreastexam
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