Generality
The breast examination is a clinical examination of the breast performed by the senologist or gynecologist. This is a painless assessment, carried out without the aid of special instruments at the specialized doctor's office.
During the breast examination, the assessment also extends to the axillary cords (where suspicious lymph nodes could be found), to the pits above and below the clavicle and to the submammary furrows.
The clinical examination of the breast is one of the fundamental stages of the path of prevention and treatment of pathological changes affecting the mammary gland .
The visit can be performed simply for information on the characteristics of the breast. For this reason, it should be done once a year starting at 25-30 years of age.
The breast examination can also be performed in symptomatic women, to ascertain the presence or monitor the course of disorders concerning one or both breasts, such as nipple secretions, inflammatory and / or painful states.
The visit is also indicated in all cases in which nodular neoformations to the self-examination of the breast are evident or palpable.
In case of suspected pathology or need for further investigation, the breast examination may be associated with other medical evaluations, such as a breast ultrasound or a mammogram, useful in the characterization of benign lesions, such as cysts and fibroadenomas, and of malignant tumors.
What's this?
The breast examination is a complete examination of the breast, painless and carried out without the use of special instruments by the senologist or gynecologist.
The objective of this evaluation is to ascertain or exclude the presence of any pathologies affecting the breast .
In the event of suspicious findings, the visit to the breast is not generally sufficient to formulate a diagnosis of breast cancer, but it is useful for framing the situation and establishing the most appropriate diagnostic-therapeutic path for the case.
What is it for?
The breast examination is a very important exam, as it allows to check for the presence of breast problems . This evaluation makes it possible to highlight the presence of nodules, nipple secretions, inflammations or painful states that affect the breasts.
Patients with diseases affecting the breast who have already received a precise diagnosis can also undergo this exam, in order to monitor the course of the same conditions and the effectiveness of the treatment to which they have been subjected.
Along with other medical evaluations, the breast examination contributes to the early diagnosis of breast cancer and is indicated to women who have passed a certain age threshold in association with other preventive screening.
How is it done?
The breast examination is divided into two parts: in the first the doctor collects as much information as possible on the patient's clinical history and lifestyle; in the second part the actual exam is performed, in which the doctor evaluates the breast through a careful observation and palpation activity.
1) History
Before beginning the examination of the breasts, the senologist takes care of the anamnestic investigation, that is of the collection of the data and information that can be useful to formulate the final diagnosis. In particular, the specialist asks the patient very specific questions to learn more:
- Clinical history : age of the menarche, regularity of the menstrual cycle and / or beginning of menopause, previous pregnancies, use of drugs (including hormone therapy), previous pathologies of the breast and any positive family history for breast cancer (previous cases of cancer in family).
- Habits and lifestyle : diet, indication of daily activity level (or tendency to become sedentary), smoking addiction and alcohol consumption.
In this first phase, the specialist also takes into consideration all the documentation of the exams previously carried out. Subsequently, the symptoms reported by the patient are evaluated, such as swelling, pain, itching, eczema, skin changes and leakage of fluid from the nipple.
2) Observation and palpation
Once the anamnesis is over, the senologist proceeds with the clinical examination based on the observation and accurate palpation of both breasts. In practice, the doctor performs all those gestures that every woman should perform monthly during self-examination:
- Inspection : the patient is seated and is observed in different positions, analyzing the shape, size, symmetry and profile of both breasts.
- Palpation : in this phase of the clinical examination, both breasts, extensions and axillary cords, the inframammary grooves and the above and subclavicular pits are palpated. The patient is examined first by sitting, then in the supine position. With delicate maneuvers that involve the use of the fingers or the entire palm of the hand, the specialist is able to assess the temperature of the skin and to detect, in some cases, the presence of edema (excess fluid in the tissues) or nodules. The visit is completed with palpation of the nipple and areola, for the evaluation of thickening and / or nodularity. With a delicate squeezing of the nipple it is possible to highlight a possible secretion.
On the basis of what he finds, the senologist can make a diagnosis and prescribe the most appropriate therapy for the patient or, based on the suspected diagnosis, ask for other examinations for further study (such as, for example, breast ultrasound, mammography and biopsy).
The breast examination normally lasts 10-15 minutes.
When is it indicated?
If the self-examination, which is carried out with the utmost regularity, does not result in anomalies, the breast examination is indicated at least once a year starting from 25-30 years of age for asymptomatic women (that is, who do not present suspicious signs for carcinoma). of the breast).
When there is a symptom of any kind on the breast, on the other hand, it is advisable to immediately contact your primary care physician and / or the specialist in breast care.
The breast examination provides information about the presence of nodules, the nature of which will then be specified by more detailed examinations: depending on the severity of the situation, the specialist doctor may decide to have the patient carry out further diagnostic investigations, such as an ultrasound scan, a biopsy (needle aspiration) or a mammogram.
Breast: signs to be reckoned with
They may be signs of the possible presence of breast cancer:
- Changes in shape and size of one or both breasts;
- Thickening or protuberances in the breast or underarm area;
- Losses of blood or fluid from the nipples that cannot be connected to pregnancy or lactation (serous or blood secretions);
- Depressions, wrinkles, reliefs or pits on the surface of the skin;
- Strange sensations (especially if they concern only one breast).
Other possible changes and unusual signs to watch out for:
- Detection of self-examination of one or more breast nodules;
- Variations in the appearance of the nipple (contours, size or position) or retraction of the same;
- Inflammations or eruptions of the skin and areola (orange peel skin, swelling, redness or sensation of heat);
- Unjustified pain in the breast or armpit.
Preparation
The patient who undergoes the breast examination should remember to bring with her the results of all the tests performed previously concerning the breast problem (if already diagnosed) and recommended by the general practitioner.
The breast examination can be carried out at any time, even if the most recommended period is the period after menstruation. Due to the tensions of the breast tissue due to the hormonal fluctuations typical of the menstrual period, it is in fact possible that no nodules are present or, conversely, false positives are detected.
The most favorable moment in which to carry out breast examination is, instead, that between the seventh and fourteenth day of the menstrual cycle (pre-ovulation).
Contraindications
The breast examination is a simple and safe diagnostic method, neither invasive nor painful. For this assessment, there are no particular precautions or contraindications.
Limitations of the visit to the breast
Even if performed by highly experienced medical professionals, the breast examination has inherent limitations to the method; in particular it tends not to recognize small tumor lesions, just as it is often not able to provide reliable indications on the nature of the findings found.
Therefore, in the presence of any slightest doubt, the clinical examination of the breast must be integrated with other complementary diagnostic investigations.
Complementary examinations
The breast examination provides a guide to the execution and contributes to the interpretation of other complementary diagnostic tests, such as mammography and / or ultrasound.
- Breast ultrasound is an ultrasound exam that is used to examine the structures of the breast. It allows to differentiate solid nodules from liquid ones, such as cysts.
This survey is considered a complementary examination for breast examination and mammography. If during these investigations there are identified nodular alterations (on palpation) or areas that generate suspicion (on the interpretation of the mammography picture), we proceed with mammary ultrasound, in order to exclude any diagnostic doubts and have the most precise response possible.
- Mammography is the radiograph of the breast, useful for identifying even very small nodules, micro-calcifications or other indirect signs of a possible neoplasm. The breast is compressed with a special device and the X-rays, passing through the mammary tissues, imprint the radiographic image on a plate (or in the computer). With mammography, around 85-90% of all cancers are identified before they are palpable.
When the outcome of such investigations is uncertain, a sample is taken from a zone or from a nodule suspected - by needle aspiration (or agocentesis) or needle-breast biopsy - for cytological or histological examination accompanied by all the biological characteristics of the fabric. These methods allow to further discriminate the nature of the lesion.
