Wirksamkeit der Selbstuntersuchung, Palpation und Mammographie zur Früherkennung des Mammakarzinoms: Erste Ergebnisse der Feldstudie München

Abstract

- Objective: We evaluated the effectiveness of self-examination, palpation by a physician, and mammography for the early detection of breast cancer. - Methods: Over a 2-year period all new cases of breast cancer in the Munich region (2.3 million inhabitants) were recorded for a population-based field study of health care. We analyzed the reported use of the three methods and associations with prognostic factors, particularly TNM stage. Results: Data on detection techniques were available for 1319 of - 2489 patients. Of these 1319 patients, 56% examined their breasts regularly and 54% participated in early detection. Both methods were used more by younger than by older women. Participation in early detection was associated with age and self-examination but not with family risk. No protective effects of different combinations of the examination methods were found for women younger than 50 years. For patients older than 50 years the pT distribution in the mammography group (67.2% pT1, 20.8% pT2, 1.6% pT3, 1.0% pT4 tumors) was more favorable than that with the other modalities. The estimated reduction in 10-year mortality was 45%. In this age group both palpation (52.6% pT1, 40.8 % pT2, 5.3 % pT3, 0% pT4) and self-examination (39.8% pT1, 39.2% pT2, 8.5% pT3, 9.7% pT4) favorably influenced the stage distribution as compared with patients using no early detection measures. In a multivariate analysis, mammography with or without self-examination (OR 0.14 and 0.07, respectively) and palpation with self-examination (OR 0.19) were associated with favorable stage distribution whereas palpation alone (OR 0.19) and self-examination alone (OR 0.77) were not. Conclusions: All three methods for early detection of breast cancer contribute to reduced mortality. Mammography cannot be replaced by self-examination and palpation in patients older than 50 years, but self-examination and palpation should be used in addition to mammography in this age group.