Update October 20, 2017 – Today Dr. Larry Lovelace, the current president of the Association of Ringside Physicians, responded to me with his personal views as a doctor with over three decades experience in combat sports with respect to the below story. Here is what he had to say –
Hi Eric. I will respond to your interesting question as a Ringside physician. (Not as the President or a representative of ARP). Ive been a Ringside doc for over 30 years. I have never performed a breast exam on a female fighter in a prefight physical. None of my partners or peers have either. The only reason I can think of to do one is if a female fighter has a known underlying breast condition that could possibly deteriorate or worsen secondary to competition. (I am not aware of the existence of any such condition )
Thanks for asking.
Fraternally;
Lovelace
Armed with the above, hopefully any fighter asked to undergo a ringside ‘breast exam’ can persuade the doctor that this is not an accepted practice.
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Update October 18, 2017 – Tara LaRosa’s opponent for the bout, Roxanne Modafferi, has weighed in as well with the following tweet confirming the experience –
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This morning MMA Fighter Tara LaRosa posted a number of troubling tweets about her experience fighting in Massachusetts –
These tweets speak for themselves.
I have reviewed the Massachusetts State Athletic Commission Regulations regarding licencing and pre-fight medical examinations. I set these out below.
These are the licensing requirements
These are the regulations requiring a physical examination prior to the bout.
While a physician does have broad discretion nowhere is a mandatory breast exam mentioned. The ‘special in-depth‘ exam is only triggered if there are ‘symptoms of ill health or physical impairment‘. It is hard to imagine how, absent compelling circumstances, a breast exam could be part of the pre-fight physical examination.
I have written to the Massachusetts State Athletic Commission for comment on whether breast exams are part of their licencing process and if so on what health and safety grounds these are justified. I will publish their reply once received.
Combat Sports Law 
what the F?
Just putting this out there, but breast exams are recommended as part of a normal physical examination for women over age 35, as the risk of breast cancer increases significantly at that age. Both of these women are over the age of 35, so best medical practices would suggest a breast exam for both as part of a standard physical examination. A cancerous tumor of the breast would fall under the guideline of “organic…deterioration”. The same goes for breast cysts that could potentially rupture in response to breast trauma.
I put all this out there because these two women are aged 35 and 39, which would put them both in the category of “manual breast examinations recommended as part of a standard physical.”
That could also all be irrelevant, and may be considering that any doc worth their salt would be able to explain that to a patient.
There are many nefarious possible explanations for this, but there are also completely medically legitimate explanations as well. There is nowhere near enough information provided for anyone to generate an informed opinion as to why the doc performed a breast exam on these women.
Tyler, thank you for your comment.
The real issue is setting.
To the extent that cancer screening is medically desired as part of the fighter licencing process that is fine. That can be achieved in a clinical setting well prior to a bout.
In the setting of a ringside examination screening for cancer symptoms seems out of place. Just like bloodwork searching for HIV or Hep is done well before a bout a cancer screening can be as well.
If a ringside physician says they need to conduct a breast exam prior to clearing a fighter then that same physician is presumably conducting testicular exam for male fighters. Same logic. I have never heard of the latter occurring.
It is also worth noting the bout in question took place years ago. Neither of these women were over age 35 at the time.
I appreciate you looking for explanations for what occurred. Perhaps there are others. Given the above though I find the explanation of cancer screening in the ringside setting problematic.
I have reached out to the ARP for comment on the propriety of this. I am hoping they provide me with the courtesy of a reply to shed more light on this topic.
I support and agree with Dr. Lovelace’s comments above. Also, I am not speaking as a representative of the ARP, or any other organizations with which I’m affiliated. As an experienced Ringside Physician, I have never performed a breast exam on a female fighter. Additionally, I do not know the circumstances surrounding this particular Ringside Physician’s decision to perform a breast exam. But, as with all issues in Medicine, all aspects need to be considered for a thorough understanding of the question at hand.
Physical exams in general can be considered in two categories — complete and focused. A breast exam is part of a complete physical exam. So the statement “a breast exam is part of an exam” is valid, but only when talking about a complete exam such as a yearly physical. A complete exam may be used for a combat sports general licensing exam, but given the low incidence of breast issues in this age range breast exams are not usually included.
Focused exams are done for one of two reasons — to more closely examine a part of the body where an issue is in question, such as an injured knee, or to screen for particular issue in question. A pre-bout exam is such a focused exam, and a breast exam is also not part of that.
But let’s look at it from another categorization of physical exams. As are most other exams in medicine, they are broken up into two categories — screening and diagnostic. Here, a screening breast exam would be for breast cancer and little else. While it is recommended according to routine preventative guidelines, short of the rare case where there could be advanced breast cancer with metastasis to other parts of the body at an unusually young age that has gone undetected in a young fighter who is likely very in tune with their body, there is no unprovoked reason for a breast exam as part of a pre-bout exam. The “focus” of a pre-bout exam is to specifically look for issues that would cause or predispose to problems in a combat sports bout. Examples here would include rib fractures, vision issues, etc.
On the other hand, Ringside Physicians must have the discretion to pursue abnormalities found on a routine, standard pre-bout or licensing exam with additional exams or testing if there as concern about something problematic. Examples here might include if a female fighter mentions that her breast is painful, evidence of a breast tissue infection (mastitis), signs of an underlying rib fracture, lymph nodes in an armpit, or problems with previous breast implants such as scarring causing a significantly asymmetric appearance or leakage of an implant. And, please note, all of these mentioned would present problems in a bout.
Bottom lines:
1. Breast exams are not part of routine pre-bout physicals given the rare incidence of issues in this age range
2. Breast exams are not part of routine annual licensing physicals, but may be required at a commissions discretion as part of routine health maintenance
3. If signs or symptoms such as those mentioned in the previous paragraph come to light on a fighter’s history, interview or physical then additional testing such as breast exam or radiologic imaging could be warranted, as with any other type of medical abnormality in any part of the body
Lastly, from a professional standard of care perspective, and for the protection of the fighters, physicians, and commissions alike, any pre-bout examinations of fighters should have a commission member or an additional medical staff member present during the exam. Additionally, in the rare situation where a breast exam is performed on a female athlete, a female chaperone should be present regardless of the physician’s gender.
Dr. Rizzo, thank you for your thoughtful comment. I very much appreciate your insights.