Illustrations by Richard Watkins / AJC

Staying safe in breast exams

For patients: What are the protocols for breast examinations?

Breast examinations are an essential part of a woman’s health, recommended annually for women over 40 and every one to three years for women under 40.

But, as revealed in an Atlanta Journal-Constitution investigation of doctor sexual abuse, not every physician adheres to professional protocol when conducting breast exams — and not every woman understands what’s expected in an examination.

The American College of Obstetricians and Gynecologists has no specific guidelines on how to perform a clinical breast exam. But doctors are taught in medical school to follow certain practices when seeing a patient, particularly for sensitive exams, according to Dr. Erica Hinz, an OB/GYN based at NYU Langone Medical Center.

Most important, she said: Uncovering only the part of the body the doctor is examining.

“We’re taught the art of draping the patient, and the whole idea of that is to expose the patient as minimally as possible,” Hinz said. “You try to keep the patient covered as much as possible because it really establishes a sense of respect and trust between the doctor and patient.”

What else can you expect at the doctor’s office? Here are some proper protocols for a clinical breast exam (CBE), compiled from Women’s Wellness Connection, the National Breast Cancer Foundation and Dr. Hinz:

• The exam should be conducted in a private room.

• You only need to undress from the waist up.

• The doctor should not watch you undress or dress. If you are unable to disrobe on your own, a doctor or an aide may assist at your request. You are allowed — in some places, encouraged — to have a chaperone. In some states, including Georgia, doctors are required to have a chaperone present when doing a breast or genital exam on a patient of the opposite sex.

• The exam usually begins with the patient seated. The doctor visually inspects the breasts for rashes, redness or large masses. The patient may be asked to lift her arms over her head or lean forward.

Then, with the patient lying down on her back, arms behind her head, the doctor palpates one breast, then the other, keeping the opposite breast covered. Palpation is done systematically by breast quadrant, with the doctor taking notes. If a mammogram is needed, the systematic observations can help the radiologist specifically target that area in more detail, Hinz said.

Doctors may also press on each nipple to check for any discharge.

• It’s not appropriate for a doctor to sit behind the patient to examine the breasts. Ideally, in fact, doctors should be visible to the patient. There’s already a power dynamic between patient and physician, and any way the doctor increases the patient’s discomfort is “inappropriate,” Hinz said.

• The doctor should not ask any questions that do not pertain to the exam. Keep in mind the breast exam’s purpose: To determine whether there’s disease, Hinz said.

Indeed, Hinz said she tells the patient exactly what she’s doing as she does it. And she welcomes the patient’s feedback during the exam.

“It’s important that at any point, if a patient feels uncomfortable for whatever reason, that they speak up,” she said. “Sometimes a doctor may not know that the way they’re saying things or approaching things is making their patient uncomfortable.”