Clinical Breast Exams

[Gerri]

I am now 4 years out from my dx and am happy to say I am doing well. All of my treatment was done at a major cancer center but I have since switched to a brand new center and have changed oncs (I followed my surgeon to the new center). I have been there for a little more than a year.

I went in for my six month check up and my Zometa infusion last month. I had my infusion first and then was led to an exam room to wait for my onc. First the PA came in and asked me some questions, followed by my onc who asked the same questions. After we chatted for a bit, he said he would give me a brief checkup and then send me on my way stating that I didn’t need a breast exam. I asked him why not and he stated that he didn’t think that I would want one since I am followed closely by my surgeon and that I probably feel like I am examined enough. I told him I definitely wanted an exam by him and as far as I was concerned, the more times I am examined the better; he seemed surprised that I felt that way. His exam consisted of me sitting upright at the edge of the exam table while he tapped his way around my breasts. I fully expected this to be followed by me laying back and having the exam done that way as well – didn’t happen. This was the third time I had seen him and I don’t seem to remember his exam being done this way. I left there feeling disappointed with how my appointment went. I have no doubt that if I ever have to go through treatment again I will switch to someone else. On the plus side, I have complete confidence in my surgeon (he gives an extremely thorough breast exam), fortunately I see him in April.

Am I putting too much emphasis on the importance of the clinical breast exam? I get yearly MRIs and mammograms – alternating every six months so I am being monitored closely. I am just curious how others feel about the importance of a clinical breast exam. I also am interested in hearing how everyone’s exams are conducted and if you feel they are a valuable tool.

Thanks everyone! I'm looking forward hearing your thoughts on this.

[AlaskaAngel]

Gerri, you are correct. Standard practice is for the practitioner to do the exam both sitting and lying. Thanks for helping to point this out.

A.A.

[Becky]

Like you, I have both my breasts so I get them examined by everyone everytime. I see my onc 2X a year, the rad onc 1-2X year, gyn, and yearly physical. This is 5-6 breast exams. I also BSE but feel they might be better.

It might be overload on my part but I'm there so why not. My GP said if I get sick (brochonitis or something) and have to be in, he will examine me everytime.

[PinkGirl]

Hey GerriGirl
When I had boobs, whenever I was at a medical appointment, except
for my dentist and optometrist, someone would be kneading my boobs
like bread dough. I thought the more the merrier ... why not ... can't
hurt ....

[AlaskaAngel]

Unless the onc has other qualities that outweigh the lack of the completeness of the exam, I would choose someone else. But I have debated the question of having the breasts palpated for lumps with my PCP. The problem I have with having them is not serious enough to keep me from having the palpation done, but still I want to raise the question...

In general, lumps have to be close to 1 cm before they can be palpated. The majority of humans who are told they don't have a lump are inclined to automatically believe that they are "okay", and having a professional complete the exam on a yearly basis like the mammogram and then tell them no lump is felt reinforces the assumption that everything is just dandy, and off they go for another year. Most of the time that works fine. And for those who have a lump palpated, the whole idea works to get them in line for further investigation. It is just a very rough estimation, not a definite conclusion.

Many people have no idea that something as small as 1 cm is as meaningful as it is when it comes to breast cancer progression.

I just have reservations about the false sense of security that can be created with examination by palpation. For someone whose lump is just a tad too small to feel at the time, it leaves most of a year before the next exam for that tiny lump to grow. It makes me think that it might be more reasonable to choose to have palpation at one time of the year, and then have the annual mammogram 6 months later.

So I continue to debate this question with my providers, and I have chosen to alternate my mammogram and the palpation exam in that way.

A.A.

[Gerri]

Thanks Becky and PinkGirl for chiming in. Like you, I think the more exams I have the more likely something might be felt - if not by one, than by another. Luckily my PCP also does a thorough exam so I do feel "covered".

AA: You bring up a great point about a false sense of security given by having a professional do an exam. I have to admit that I do feel "okay" after getting the "all clear". I plan my yearly physical, 6 month check-up with my onc, and my six month check-up with my surgeon spaced out through the year so I feel more "covered". Getting my mammogram and MRI alternating every six months makes me feel better too. However, my surgeon mentioned eliminating the mammogram and just having a yearly MRI due to unnecessary exposure to radiation - I'm not quite sure how I feel about that yet and will see if he brings it up again in April. I have had two biopsies in the past year - one after my mammogram and one after the MRI - thankfully both were benign. Were these "unnecessary"? I don't think so because I am considered "high risk" (family history too) and although the areas of concern were small (different breasts each time), the radiologist felt biopsies were in order. The past few days I have had some tenderness in one breast (noticed in the shower when water hit on an area) and if it is still bothering me in April I will probably insist on having a mammogram.

As for my onc, he is "okay" - he talks to me and seems to listen if I have something to say. He is a bc specialist so I guess I just was expecting more in the way of exams. I think I will give him one more shot (could have been a super-busy day) before I make any plans to move on.

Thanks again for the input, I really appreciate everyone's thoughts.

[v-ness]

this fall when i first got diagnosed i was getting felt up every week and that was fine by me! i am also of the 'more the merrier' mindset. it doesn't and can not hurt. i paid attention to how they do it, in addition to studying the card the cancer care office gave me (and i hung on my shower head). i still don't feel like the expert the docs are, but i do the BSE's quite regularly. probably even more regularly than i need. in my case, the tumor grew to be 1 cm and greater in a short time so i'll remain vigilant ever after.

you can always lay down on the guy next time. then he has no choice but to examine you that way. v