Breast Examination

Breast examinations are performed for a number of clinical reasons.  Patients, usually female, may present with mastalgia (breast pain), nipple changes (skin or discharge) or more commonly a breast lump.

Breast cancer is a common condition, nearly 50,000 women are diagnosed with this each year in the UK, it is therefore likely that whatever area you specialise in you will encounter breast cancer.   Due to this fact it is commonly examined upon, as it is an important skill to know.

As this is an intimate examination it is pertinent to gain a good rapport with your patient, maintain good communication and ensure the patient’s dignity at all times.  For the purpose of examinations you will be provided with a mannequin, however you should pretend it is a real patient and talk to it as such, which will also form part of the marking scheme.

Subject steps

  1. Ensure that patient is appropriately covered and thank them.

    Wash your hands and report your findings to the examiner.  If you had noticed any lumps then you should be able to comment on its size, position, mobility, consistency, also noting its relationship to other structures (i.e. skin, deep muscle).

An extension to this station would be the investigation of a breast abnormality such as a lump.  For this you should understand what is meant by “triple assessment” , which is usually performed at an outpatient clinic.

  • Clinical examination
  • Imaging
  • Biopsy

Imaging modality will primarily depend upon the patient’s age. Younger women have denser breast tissue and so the use of mammography is of limited use; in these patients ultrasound is the best first form of imaging. Older patients may undergo both mammography and/or ultrasound.

If there is any abnormality detected in the examination, or imaging, then biopsies are taken. This can be in the form of FNAC (Fine Needle Aspiration Cytology) or a core (Tru-Cut) biopsy. If neither of these provide a reliable answer then an open surgical biopsy may be required.