Indications for Breast Examination
Any woman seeking medical care for a breast complaint should have a thorough clinical breast
examination (CBE). CBE is also indicated as part of breast cancer
screening. The following summarizes recommendations about breast
examination:
Women under 40 years of age
- American Academy of Family Physicians:
CBE every 1 to 3 years from age 30 to 39.
- American Cancer Society:
CBE every 3 years from age 20 to 39.
- American College of Obstetricians and Gynecologists:
Women over 18 years should have CBE during the periodic evaluation,
yearly, or as appropriate.
- Canadian Task Force on the Periodic Health Examination
and the U.S. Preventive Services Task Force:
Physicians may elect to perform CBE on women under age 40
who are at high risk, especially those whose first-degree
relatives have had breast cancer diagnosed before menopause.
Women 40 years of age and over
- American Academy of Family Physicians, American Cancer
Society, American College of Obstetricians and Gynecologists,
and American College of Physicians:
Annual CBE should be performed on women 40 years of age and
older.
- Canadian Task Force on the Periodic Health Examination:
CBE should be performed on women aged 50 and over every 1
to 2 years. Physicians may elect to perform CBE on women under
age 50 who are at high risk, especially those whose first-degree
relatives have had breast cancer diagnosed before menopause
(under review).
- U.S. Preventive Services Task Force:
CBE should be used in conjunction with screening mammography
in women age 50 to 69. There is insufficient evidence to recommend
for or against CBE in women over 70 or between 40 and 49 (U.S. Preventive Services Task Force).
In asymptomatic women CBE should be performed in conjunction
with mammography for breast cancer screening. There has been
considerable discussion and controversy about when to start
screening asymptomatic women with mammography. Many organizations
listed above for CBE recommend that women over 50 years of age
have routine screening mammograms every 1 to 2 years. There
is more debate over when to begin screening in women younger
than 50 (breast complaint, breast cancer
screening with mammography).
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