How to Spend the 2 Minutes for Your Breast Exam

Part of being satisfied with a 2 minute breast exam is deciding whether enough has been done.

Traditionally, and here tradition means for the last 100 years or so, breast examination has included steps looking at the breast while the woman moves her arms different ways, feeling under the arms and over the shoulder, and palpating the patient’s breasts while she is lying down.

Before a person assumes that all of these steps are necessary, it is important to ask: 1) where did these steps come from? and 2) what happens if the breast examination is simplified to just one step?

The simple answer is that the multiple steps of doing a breast exam were defined before mammograms had even been invented, in fact, before x-rays had even been discovered. More importantly, these steps were defined before surgeons routinely used pathology examination of tissue taken with a biopsy to decide even if a mass was cancer.

As amazing as it may seem, less than 100 years ago, surgeons relied on their clinical impression, what a mass felt like and looked like, to decide if a woman had breast cancer. Then, in 1922, a study by William MacCarty at the Mayo Clinic documented that the impression - the opinion actually - of the surgeon was wrong 6 to 11 percent of the time either way. If the surgeon was certain that a mass was cancer, he was wrong 6 percent of the time; and, if he was certain that a mass was benign, he was wrong 11 percent of the time.

So much for saying whether a mass is cancer based just on what it feels like!

Since the steps of observation, looking for retraction and guessing about nodes were really just intended to guide what turned out to be an unreliable decision process, it seems reasonable to drop those steps.

In 1982, Leo Mahoney and Adele Csima, two Canadian ressearchers, found that almost all cancers and breast masses that can be found by CBE were found by examining the patient while she was lying down, and this was before mammograms came into use to screen women for breast cancer. [Note that in some countries, it is customary to examine the woman while she is sitting rather than lying down; but with either method, with the woman sitting or with the woman lying, the breast tissue is being palpated against the ribs of the chest.]

The simplified CBE worked; and, as explained above, Mahoney and Csima found that it took only about 2 minutes.

Their work is supported by a recent review of the steps in the diagnosis of 1,401 breast cancers at three different hospitals in the San Francisco Bay Area. In this study, most of the women also had mammograms. It was found that a simplified examination would have missed only one of the 1,401 cancers if the women also had a mammogram. But note: 17 percent of these women had a negative mammogram at the time of diagnosis. This was a mammogram that was correctly read, and still did not show the cancer. CBE was the only way these cancers were found.

It is important that the CBE checks all of the areas where breast cancer can start. This means not just the middle part of the breast around the nipple, but all the area from the clavicle (collar bone) to the line just below the bottom of your bra, and all the area from one side of your chest to the other side.

“2 Minutes” on this website means your doctor will palpate your breasts for a full 2 minutes while you are lying down.