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

Updated: Apr 10, 2019
  • Author: Erin V Newton, MD; Chief Editor: Marie Catherine Lee, MD, FACS  more...
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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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