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and Novartis; and has served as local and national principal investigator for trials within his US Oncology research network. Any research payments go toward costs to conduct the research. J.L. Passos-Coelho reports honoraria from Roche, Novartis, and Pfizer; consulting/advisory roles for Roche, Novartis, and Pfizer; research funding from BMS; and travel and accommodation expenses from Roche and Astellas. M. Gil-Gil reports honoraria from Roche, Pfizer, Novartis, and Pierre Fabre; consulting/advisory roles for Daiichi Sankyo, Pfizer, and Novartis; and travel and accommodation expenses from Daiichi Sankyo and Roche. B. Bermejo reports speakers bureau for Novartis, Celgene, and Roche, and travel and accommodation expenses from Pfizer. D.A. Patt reports employment with Texas Oncology, McKesson Specialty Health (self), and Mednax (husband); leadership for Texas Oncology-EVP (self) and Mednax (husband-National Medical Director, Pediatric Cardiology); and stock in Mednax (husband). E. Ciruelos reports consulting/advisory roles for Roche, Novartis, Lilly, and Pfizer (self and immediate family member); speakers bureau for Roche, Novartis, Lilly, and Pfizer; and travel and accommodation expenses from Roche and Pfizer. P. Villagrasa reports honoraria from NanoString Technologies and is a cofounder of Reveal Genomics. E. Petricoin reports leadership positions with

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Both the American Cancer Society and National Comprehensive Cancer Network recommend annual clinical breast examination (CBE) along with screening mammogram (SM) for patients starting at 40 years of age. However, patients with a palpable breast mass should have a diagnostic mammogram (DM) during workup. Review at our institution demonstrated that 11% of patients with newly diagnosed breast cancer and self-identified breast mass had SM instead of DM. This led us to question whether primary care physicians (PCP) perform CBE prior to ordering mammography. As part of the routine preimaging screening, patients were asked if they had undergone breast examination by a medical provider prior to mammogram order. Data on mammogram type, ordering physician specialty, and presence of symptoms on day of mammogram were recorded. Of 6,109 mammograms, 4,823 were ordered by PCPs. CBE was performed prior to 67.2% SM and 64.8% DM (p = 0.12). OB/GYN performed statistically significantly higher CBE (81.6%) compared to internal (45.4%) and family (50.5%) medicine physicians (p < 0.001). Of patients with self-reported breast symptoms, 8.7% had SM ordered rather than DM. Despite recommendations, approximately 1/3 of women report not having CBE prior to mammogram. The chances of having a CBE varied significantly by PCP specialty. Lack of CBE can lead to incorrect type of mammogram, with possibly increased cost and delay in diagnosis. Further evaluation is needed to understand why CBE was not performed in some patients.