Many women tell me that when they go for their annual gynecological exam, the doctor's focus seems to be "below the waist;" breasts seem to be a forgotten element of the gynecological exam. In some cases, women tell me that they "kinda" got a clinical breast exam but it was so fast and perfunctory they weren't even sure if it really happened. This is a problem.

Technically, the clinical breast exam is the responsibility of your gynecologist, as well as of your primary care provider (PCP). And if you are a breast cancer survivor, then add your oncology specialist to the list. So what has happened in the medical field to cause our physicians to slight or even ignore this important clinical exam?

Sadly, medical school students today receive an average of only one to two hours of instruction about this part of a woman's anatomy. Adding to the problem is the fact that doctors have become so specialized that gynecology focuses ever more closely on the pelvis, to the detriment of the other parts of the female anatomy.

PCPs are so busy these days that most people consult them only for issues requiring immediate attention - a sprain, the flu, or some other relatively urgent condition. In those cases, the time spent with your doctor is dedicated to relieving your symptoms and not on, "By the way, could you please check my breasts as long as I'm here."

If you are a breast cancer survivor, you're lucky if you get to see your oncologist once a year - if indeed you haven't already been handed back to your PCP for long-term follow-up. With so many women being newly diagnosed with breast cancer, there aren't enough hours in the day for oncologists to also continue to follow the long-term survivors.

Instead of counting on your doctors to remember to do this important annual check-up, you need to count on YOU to speak up. First, be sure that you are assuming your full responsibility, by doing your monthly breast self-exam.

Second, when you do see your gynecologist or PCP, if the above-the-waist exam is brief, stop them before they leave the room and say, "Can you do a more thorough exam of my breasts, please, so I can feel confident that there are no issues that warrant further evaluation?"

Consider asking your gynecologist or PCP if there is a nurse practitioner in the office who can conduct a clinical breast exam annually. Nurses are known for doing a really thorough breast exam and they can also teach you exactly how to perform a proper breast self-exam.

So who's responsible for your breast health? If your breasts could talk, they'd ask you to look out for them. So do!