M9.2019 Undertake a clinical examination of the breast

Overview

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 policies. Version No 2

Knowledge and Understanding

You will need to know and understand:

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

Performance Criteria

You must be able to do the following:

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 individual's 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 individual's 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

Additional Information

his National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB6 Assessment and treatment planning