Abstract
Screening clinical breast examination (cbe) is controversial; the use of cbe is declining not only as a screening tool, but also as a diagnostic tool. In the present study, we aimed to assess the value of cbe in breast cancer detection in a tertiary care centre for breast diseases. This retrospective study of all breast cancers diagnosed between July 1999 and December 2010 at our centre categorized cases according to the mean of detection (cbe, mammography, or both). A cbe was considered "abnormal" in the presence of a mass, nipple discharge, skin or nipple retraction, edema, erythema, peau d'orange, or ulcers. During the study period, a complete dataset was available for 6333 treated primary breast cancers. Cancer types were ductal carcinoma in situ (15.3%), invasive ductal carcinoma (75.7%), invasive lobular carcinoma (9.0%), or others (2.2%). Of the 6333 cancers, 36.5% (n = 2312) were detected by mammography alone, 54.8% (n = 3470) by mammography and cbe, and 8.7% (n = 551) by physician-performed cbe alone (or 5.3% if considering ultrasonography). Invasive tumours diagnosed by cbe alone were more often triple-negative, her2-positive, node-positive, and larger than those diagnosed by mammography alone (p < 0.05). A significant number of cancers would have been missed if cbe had not been performed. Compared with cancers detected by mammography alone, those detected by cbe had more aggressive features. Clinical breast examination is a very low-cost test that could improve the detection of breast cancer and could prompt breast ultrasonography in the case of a negative mammogram.
Highlights
Breast cancer is the most common cancer in women, with a lifetime probability of 11.5% and 24,400 new cases diagnosed in 2014 in Canada; by 2014, the mortality rate had decreased to 18.4 women per 100,000 from 30.7 women per 100,000 in 19841
Compared with cancers detected by mammography alone, those detected by cbe had more aggressive features
Clinical breast examination is a very low-cost test that could improve the detection of breast cancer and could prompt breast ultrasonography in the case of a negative mammogram
Summary
Breast cancer is the most common cancer in women, with a lifetime probability of 11.5% and 24,400 new cases diagnosed in 2014 in Canada; by 2014, the mortality rate had decreased to 18.4 women per 100,000 from 30.7 women per 100,000 in 19841. Compared with control subjects, women invited to screening had a 20% relative risk reduction for breast cancer mortality[2,3,4]. If screening mammography has been shown to lower breast cancer–specific mortality, controversy still remains with respect to clinical breast examination (cbe) in a screening context. Data derived from the Ontario screening program suggested that mammography and nurse-performed cbe result in a higher sensitivity than mammography alone, but with more false positives[9]; those results have minimal carryover in real-world practice because the cbes in that study were performed by nurses who had received special training, a situation that would be clinically applicable only at the cost of great effort[10]. Screening clinical breast examination (cbe) is controversial; the use of cbe is declining as a screening tool, and as a diagnostic tool. We aimed to assess the value of cbe in breast cancer detection in a tertiary care centre for breast diseases
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