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Clinical breast examination (CBE) seeks to detect breast abnormalities or evaluate patient reports of symptoms to find palpable breast cancers at an earlier stage of progression.Treatment options for earlier-stage cancers are generally more numerous, include less toxic alternatives, and are usually more effective than treatments for later-stage cancers. For average-risk women aged 40 and younger, earlier detection of palpable tumors identified by CBE can lead to earlier therapy. After age 40, when mammography is recommended, CBE is regarded as an adjunct to mammography. Recent debate, however, has questioned the contributions of CBE to the detection of breast cancer in asymptomatic women and particularly to improved survival and reduced mortality rates. Clinicians remain widely divided about the level of evidence supporting CBE and their confidence in the examination. Yet, CBE is practiced extensively in the United States and continues to be recommended by many leading health organizations. It is in this context that this report provides a brief review of evidence for CBE's role in the earlier detection of breast cancer, highlights current practice issues, and presents recommendations that, when implemented, could contribute to greater standardization of the practice and reporting of CBE. These recommendations may also lead to improved evidence of the nature and extent of CBE's contribution to the earlier detection of breast cancer. (CA Cancer

WE live in an age of rapidly advancing technologies: we have harnessed nuclear energy, revolutionized our way of life with electronic computers, landed on the moon, and are standing on the threshold of a biotechnology that promises not only to make routine the exchange of vital organs among members of different species, but to engineer the basic nature of life itself. In the midst of these developments, psychologists have in the last decade begun perfecting the technological consequences of their discipline. The widespread application of principles of behavior analysis in clinics, hospitals, prisons, and schools has already validated the promise of an essential contribution to our advanced form of civilization which will be made by an effective technology of human behavior.It is surprising, therefore, that virtually no attention has been directed by psychologists toward the application of behavior technology to one of the most ubiquitous and widely shared aspects of their professional life-college teaching. When one considers that the cornerstone of modern experimental psychology has been the investigation of the phenomena of learning, it is remarkable that the college classroom has been almost totally omitted from the list of experimental environments where such phenomena are isolated, studied, and controlled. Perhaps the most painful reminder of this omission on the part of academic psychology is that the problem of effectively evaluating teaching-felt urgently by administrators, faculty, and students alike-has in practice been left for the students to 1 The authors would like to express deep appreciation to the student managers whose energies and ideas have contributed greatly to these efforts. They owe particular gratitude to

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This study was designed to evaluate the effect of breast examination training with silicone models on the detection of lesions in natural breast tissue. Six women with a total of 13 benign breast lumps were examined by 20 trainees before and after a 20--30 minute training session or a period of unrelated activity. Following the training, percentage of correct detections, duration of examination, and reports of false positives increased. Confidence in correct detections and false positives also increased, although confidence in correct detections was greater than confidence in false positives. The results indicate the effectiveness of the training and suggest a need for a more complex model for training discrimination between normal nodularity and breast lesions.