Are You Using Enough Force on Breast Exams?

Physicians conducting clinical breast examinations (CBEs) who don’t apply enough force during palpation risk missing masses, researchers discovered.

The findings illustrate the need for using sensor technology to improve clinical breast exam skills, the authors argue.

Key Points:

- Many physicians will miss deep tissue masses when conducting a breast exam because they are not applying enough force during palpation.

- The optimal palpable force for deeper lesions is between 12 and 17 newtons.

- Sensor technology could help to better train and assess physicians in conducting more accurate breast exams.

"Variations in palpable force used during a CBE cannot be reliably measured by human observation alone," said Carla Pugh, MD, PhD, director of patient safety and education at University of Wisconsin Hospital and Clinics, Madison, and principal investigator of the study. "Our findings revealed that 15% of the physicians we tested were using a technique that put them at significant risk of missing deep tissue lesions near the chest wall."

The study results were discussed in a correspondence to the New England Journal of Medicine. The authors suggest that using the sensor technology could help assess clinical skills as well as allow for "objective, evidence-based training, assessment and credentialing."

For the study the researchers tested 553 physicians recruited at three annual clinical meetings in 2013 and 2014: 136 at the American Society of Breast Surgeons, 236 at the American Academy of Family Physicians, and 181 at the American College of Obstetricians and Gynecologists. The physicians were asked to perform a simulated CBE under conditions that mimicked an office visit for a patient who said she believed she had felt a mass during a self-exam, but could no longer feel it.

Physicians who pressed with a force of less than 10 newtons of force were at significant risk for missing deep-tissue masses, the authors found. If the mass was near the surface, however, accuracy did not improve by applying more force. The optimal palpable force for deeper lesions was found to be between 12 and 17 newtons.

“I want to spark a serious conversation about the potential for high-end, mastery training in the health care profession,” Pugh said in a news release. “Health care is at a critical juncture where there are huge opportunities for major information exchanges that can empower physicians and patients. Both patients and physicians will benefit from clinical-skills performance data.”