Abstract
ObjectiveA breast exam is a low-risk, low-cost method for early detection, which is crucial for improved mortality. However, clinical breast exams (CBE) and breast self-exams (BSEs) remain controversial with unclear guidelines. This study analyzes the efficacy of these two exam types in evaluating palpable breast masses.MethodsThis retrospective cross-sectional study included 2019 medical records from Epic of women with breast lumps. Patient demographics, provider types, and breast exam types were recorded. Primary outcomes were detection of cancer and positive ultrasound finding. Fisher’s exact tests and two-sample t-tests determined the statistical significance of the association between the outcomes and categorical and continuous variables.ResultsOf 462 breast masses, 69 demonstrated positive ultrasound findings, with 26 of those yielding cancer; 96% of cancers and 81% of ultrasound findings resulted from patient-identified lumps. Of provider-identified lumps, 100% of cancers and 92.3% of positive ultrasound findings were diagnosed by MDs (doctors of medicine) rather than midlevel providers. There was no statistically significant difference in identifying cancer or positive ultrasound finding between CBEs and BSEs (p = 0.3709 and p = 0.1556).ConclusionDespite no difference between CBEs and BSEs in identifying cancer or positive ultrasound finding, 25 of the 26 breast cancers were initially detected by patients, while only one of 26 was detected by CBE. BSEs detect breast cancers. Although some guidelines encourage CBEs over self-exams, not all CBEs are equal.Key messageThere is no significant difference between CBEs and BSEs in identifying cancer or positive ultrasound finding. The majority of cancers were initially identified by patients. BSEs detect breast cancers and women should continue performing them. Not all CBEs are equal. CBEs by MDs, especially women health specialists, are generally more effective than those by midlevel providers.
Highlights
Breast cancer is the leading cancer in American women, aside from skin cancer
Even in the United States, breast self-exams (BSEs) are valuable for women who are younger than the age of 40 or 50 years, the age at which mammography is recommended, and who are at higher risk of mortality from breast cancer due to race or family history [3]
The purpose of this paper is to examine the efficacy of clinical breast exams (CBE) and BSEs in evaluating palpable breast masses and identifying malignancies or any positive ultrasound results
Summary
Breast cancer is the leading cancer in American women, aside from skin cancer. A woman is diagnosed with breast cancer in the United States every two minutes. One in eight women in the United States will develop breast cancer. Tools for early detection include clinical breast exams, breast self-exams, and mammograms. A clinical breast exam (CBE) is performed by a medical provider, while a breast self-exam (BSE) is performed by the patient. In less-developed countries where imaging and CBEs are not as readily available, BSEs are often the only method for early detection of breast cancer [2]. Even in the United States, BSEs are valuable for women who are younger than the age of 40 or 50 years, the age at which mammography is recommended (depending on the guideline), and who are at higher risk of mortality from breast cancer due to race or family history [3]
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