- Question from Kathy: The American Cancer Society (ACS) has done a very good job instructing women on the proper technique for BSE (breast self-exam). Are the doctors that are attending medical schools today being taught to do a better CBE (clinical breast exam) than their predecessors?
- Answers - Cecilia Brennecke I'm part of a group in Maryland that travels around the state and teaches the "Mammocare" method to practicing physicians, usually primary-care physicians. That work is funded by the CDC (Centers for Disease Control) because Maryland has a very high breast cancer rate. I don't know what medical schools are doing about it, but in my breast center, we offer clinical breast exams performed by the radiologist, and it's a highly sought-after service.
- I have patients who complain to me that their doctors do poor breast exams, and they don't know what to say or how to handle it. I think it may be important for you to say just before the exam starts that you really need the doctor to do a very careful exam, that it's very important to you, and that you are really depending on him or her to do this in conjunction with your own self-exam as well as mammography and other tests, as needed. Making this request may make a significant difference, but if the doctor does not respond in a way that is satisfactory to you, maybe you should find another doctor, or at least make sure there are enough other doctors on your team who are providing this important part of your examination.
- Cecilia Brennecke I agree. The gynecologist is the primary-care physician for many women. Their area of expertise is not the breast but the pelvis, and they may not be comfortable with the breast exam. I agree with Marisa that you should impress upon the doctor that this is important to you. The breast exam is not an easy exam to do, and that may be why they're not doing a good job, or are doing a cursory job.
- When you examine your own breast, you can expect to feel "neighborhoods" or regions that have distinct variations. For example, the upper outer quadrant may feel like a scouring pad or a collection of grapes.
- Cecilia Brennecke I always need food analogies, Marisa!
- This scouring pad comparison is very useful because I haven't found a piece of food that describes a cloud-like region that is consistently very firm. I think that gefilte fish would also be a good alternative description.
- Cecilia Brennecke I use oatmeal and tapioca. If you feel a rock in the oatmeal, it doesn't belong.
- It's like the Sesame Street images—which of these things does not belong with the others?
- Cecilia Brennecke When you feel the upper outer quadrant—which is the area between the nipple and the armpit—and it feels lumpier than the rest of the breast, that's normal. The same area on the other breast should feel somewhat the same. Not exactly the same, but somewhat the same.
- At the very bottom of the breast, just above the crease or the fold, where an under wire would rest, the breast may have a very smooth or thick consistency, like the rind of a piece of fruit. It's thick and smooth and the edge of it can feel like a ridge. Don't expect our descriptions to fit your breasts exactly. Our only message here is that the breast tends to have different patterns of consistency, depending on the area. Get to know how your own breast tissue feels, and if you have any questions, bring them to the attention of your doctor.
- Cecilia Brennecke I think women are afraid of the self-exam because it's difficult. They're afraid that they would not find something that is important, or they would find too much and bother the doctor. But it's free and it works—you just have to practice. I think NOT doing something that could save your life is a lost opportunity.
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