Undertake a clinical examination of the breast

This standard is about undertaking a clinical examination of the breast to identify regions of potential abnormality. Any such regions are characterised and categorised, which together with any additional information is used to undertake or direct further examinations and report the results. This examination will include examining any mammographic images that have been produced. This will be undertaken either on the initiative of the operator as an integral component of a breast investigation, or in response to a request from a health professional. Key people are those involved in the individual's care and others involved in provision of services. Users of this standard will need to ensure that practice reflects up to date information and

1. apply standard precautions for infection prevention and control

   and other appropriate health and safety measures

   2. ensure the environment is conducive to maintaining the privacy

   and dignity of the individual

   3. check the identification details before commencing the

   examination in accordance with local policies and procedures

   4. communicate with the individual / key people to facilitate their

   understanding of and co-operation with the examination

   5. establish the individuals capacity to understand the procedure

   with the help of key people if necessary

   6. clearly explain the procedure and possible outcomes, including

   risk, benefits and limitations

   7. obtain valid consent for the procedure in accordance with national

   and local guidelines

   8. respect the individuals privacy, dignity, beliefs and decisions

   9. confirm the appropriateness of the request according to local

   guidelines

   10. review clinical information and available clinical history and

   examine any previous imaging

   11. examine the breast and associated structures

   12. interpret any clinical areas perceived as abnormal to determine

   their nature

   13. make a full, accurate and clear record of the size, position and

   nature of any abnormality, its interpretation, categorisation and

   further action required

   14. request appropriate imaging procedures to further elucidate areas

   of interest

   15. examine all images and characterise and categorise any

   abnormalities in line with local protocols and national guidelines

   16. correlate the mammographic findings and results of other

   diagnostic imaging procedures with the findings from the clinical

   history and clinical examination

   17. provide the individual with information relating to the examination

   where necessary

   18. explain the process for obtaining results

   19. communicate all relevant information to other members of the

   multi-disciplinary team according to local protocols

1. legal, organisational and policy requirements relevant to your role,

   the role of others in your organisation and the activities being

   carried out

   2. the relevant national and local standards, guidelines, policies and

   procedures that are available and how and when they should be

   accessed

   3. the importance of respecting individuals culture, privacy, dignity,

   wishes, beliefs and decisions

   4. the limitations of your own knowledge and experience and the

   importance of operating within your scope of practice

   5. the roles and responsibilities of other team members

   6. the importance of obtaining valid consent in line with national and

   local guidelines

   7. the purpose of the breast diagnostic and screening services

   8. the quality assurance programmes in symptomatic, assessment

   and breast screening services

   9. the importance and implications of correct individual identification

   10. local guidelines for acceptance of requests for mammography

   11. population screening in the detection of disease

   12. the anatomy, physiology and pathology of the breast, axilla,

   subcutaneous tissues and associated structures

   13. mammographic manifestations of breast disease and normal

   variations as a result of age, hormonal state, surgery and

   radiotherapy

   14. the changes in images, physical appearance or feel of breast

   tissue as a result of age, surgery, hormonal state, medication or

   radiotherapy

   15. the pathophysiology of breast disease

   16. areas of the breast particularly at risk of developing abnormal

   appearances or where cancer detection may be important

   17. the importance of optimising the radiation dose received by the

   individual

   18. the features of mammographic images and the digital imaging

   process

   19. how to identify the correct orientation and location of the breast on

   a digital image

   20. the clinical findings associated with recognising normal, benign

   and malignant tissue

   21. the interdependency and significance of the recorded information

   and the mammographic appearance

   22. how to obtain previous records and images

   23. how to adapt communication styles, ask questions, and listen

   carefully in ways which are appropriate for the needs of the

   individual

   24. methods of communicating difficult and complex information to

   individuals and key people

   25. the importance of providing individuals and key people with

   opportunities to ask questions and increase their understanding

   26. the information that should be given to individuals before, during

   and on completion of the examination

   27. how to undertake a clinical examination of the breast and

   associated structures

   28. the importance of minimising any unnecessary discomfort, and

   how to do so

   29. the range of options available following clinical examination, and

   role and importance of additional and complementary imaging and

   biopsy techniques

   30. decision-making strategies, categorisation of risk of malignancy,

   determination of likely pathology and criteria for subsequent

   action according to local protocols

   31. the role and importance of mammography in ‘triple assessment

   32. the strengths and weaknesses of mammography and the

   interdependency and significance of the clinical mammographic

   and ultrasound appearances

   33. the risks of breast disease associated with family history,

   hormone replacement therapy

   34. breast surgery and treatment and how these might influence

   imaging appearances

   35. how to keep full, accurate and clear records in line with

   organisational procedures

This standard links with the following dimension within the NHS

Knowledge and Skills Framework (October 2004):

Dimension: HWB6 Assessment and treatment planning