What are the roles of breast self-exam (BSE) and clinical breast exam (CBE) in breast cancer screening?

Answer

Breast self-examination (BSE) and clinical breast examination (CBE) are inexpensive and noninvasive procedures for the regular examination of breasts (ie, monthly BSE and annual CBE). Evidence supporting the effectiveness of these 2 screening methods is controversial and largely inferred.

Even with appropriate training, BSE has not been found to reduce breast cancer mortality. In fact, the majority of the expert groups have revised their recommendations to include discussions about the benefits and limitations of this technique or a more general education about breast self-awareness.^[8]

For example, ACOG distinguishes between BSE, which it does not recommend, from breast self-awareness, which it endorses.^[6] Unlike BSE, breast self-awareness does not involve routine or systematic breast self-examination for the purpose of detecting breast cancer. Rather, it is a woman's attunement to the normal appearance and feel of her breasts, so that she can notify her health care provider if she experiences breast changes such as pain, a mass, new onset of nipple discharge, or redness.^[6]

With increasing improvements in treatment regimens for early, localized disease, CBE, particularly among women younger than 40 years, continues to be recommended by many groups, including ACOG and ACS. Randomized clinical trial results support combining CBE with mammography to enhance screening sensitivity, particularly in younger women in whom mammography may be less effective and in women who receive mammograms every other year as opposed to annually.

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Yankaskas BC, Haneuse S, Kapp JM, Kerlikowske K, Geller B, Buist DS, et al. Performance of first mammography examination in women younger than 40 years. J Natl Cancer Inst. 2010 May 19. 102 (10):692-701. [Medline]. [Full Text].
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Anatomy of the breast.
Intrinsic subtypes of breast cancer.
Breast cancer. Intraductal carcinoma, comedo type. Distended duct with intact basement membrane and central tumor necrosis
Anatomy of the breast. Courtesy of Wikimedia Commons (Patrick J Lynch, medical illustrator).

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Author

Erin V Newton, MD Assistant Professor of Clinical Medicine, Division of Hematology/Oncology, IU Simon Cancer Center, Indiana University School of Medicine; Staff Physician in Palliative Care, VA Medical Center

Erin V Newton, MD is a member of the following medical societies: American Society of Clinical Oncology, Multinational Association of Supportive Care in Cancer

Disclosure: Nothing to disclose.

Coauthor(s)

Sara J Grethlein, MD Associate Dean for Undergraduate Medical Education, Indiana University School of Medicine

Sara J Grethlein, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Hematology, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Marie Catherine Lee, MD, FACS Associate Professor, Department of Oncologic Sciences, Department of Surgery (Joint Appointment), University of South Florida Morsani College of Medicine; Associate Member, Comprehensive Breast Program, Moffitt McKinley Outpatient Center

Marie Catherine Lee, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society of Clinical Oncology, Association for Academic Surgery, Association of Women Surgeons, Florida Society of Clinical Oncology, Society of Surgical Oncology, Society of University Surgeons

Disclosure: Received research grant from: National Cancer Institute/National Institutes of Health; Department of Defense.

Additional Contributors

Robert C Shepard, MD, FACP Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International

Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American Association for Physician Leadership, European Society for Medical Oncology, Association of Clinical Research Professionals, American Federation for Clinical Research, Eastern Cooperative Oncology Group, Society for Immunotherapy of Cancer, American Medical Informatics Association, American College of Physicians, American Federation for Medical Research, American Medical Association, American Society of Hematology, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Leona Downey, MD Assistant Professor of Internal Medicine, Section of Oncology and Hematology, University of Arizona, Arizona Cancer Center

Leona Downey, MD is a member of the following medical societies: American Geriatrics Society, American Society of Clinical Oncology, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Julie Lang, MD Associate Professor of Surgery, Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California

Julie Lang, MD is a member of the following medical societies: American College of Surgeons, American Society of Breast Surgeons, American Society of Clinical Oncology, Association for Academic Surgery, and Society of Surgical Oncology

Disclosure: Genomic Health, Grant/research funds, Speaking and teaching; Agendia, Grant/research funds, Speaking and teaching; Surgical Tools, Grant/research funds, Research; Sysmex, Grant/research funds, Research

Robert B Livingston, MD Professor of Clinical Medicine and Director, Clinical Research Shared Services, Arizona Cancer Center

Robert B Livingston, MD is a member of the following medical societies: American Association for Cancer Research, American Federation for Clinical Research, and American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Alison T Stopeck, MD Professor of Medicine, Arizona Cancer Center, University of Arizona Health Sciences Center; Director of Clinical Breast Cancer Program, Arizona Cancer Center; Medical Director of Coagulation Laboratory, University Medical Center; Director of Arizona Hemophilia and Thrombosis Center

Alison T Stopeck, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Clinical Oncology, American Society of Hematology, Hemophilia and Thrombosis Research Society, and Southwest Oncology Group

Disclosure: Genentech Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; AstraZeneca Grant/research funds Other

Rachel Swart, MD, PhD Assistant Professor of Medicine, Department of Hematology and Oncology, Arizona Cancer Center, University of Arizona

Rachel Swart, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society of Clinical Oncology, Arizona Medical Association, and Southwest Oncology Group

Disclosure: Roche Grant/research funds Other

Patricia A Thompson, PhD Assistant Professor, Department of Pathology, University of Arizona College of Medicine

Disclosure: Nothing to disclose.

What are the roles of breast self-exam (BSE) and clinical breast exam (CBE) in breast cancer screening?

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