Adequacies and inadequacies of breast examinations by physicians in mass screening

Abstract

Preliminary findings in a mass screening program for breast cancer give hope that repetitive breast examinations by physicians, together with mammography, will result in a lowered mortality from this disease. A random sample of 31,000 “study” women, aged 40–64, and a similarly constituted “control” group have been under observation. Among the women screened, it has been found that clinical and radiologic examinations contribute independently to case detection, that the clinical examination is effective at all ages, and that mammography's effectiveness is greatest in women aged 50 and over. A substantially lower 3½‐year case fatality rate has occurred in the study group as contrasted with the control group. To date, the effect on mortality is most noticeable for women aged 50–59 at diagnosis, follow‐up must continue for as much as 10 years to determine whether this reduction in deaths will be maintained.

From the Lung to the Breast:a Young Lady in Distress ' a Case Report and Literature Review

“…A number of "classic" characteristics of breast cancerous lesions have been described such as single lesion, hard, immovable, irregular borders and size ≥2 cm. However, these features individually do not distinguish well between cancers and benign lesions because a significant number of malignant lesions were soft or cystic (38 percent), freely movable (61 percent), regular (41 percent), and less than 2 cm in size (28 percent) in the study conducted by Venet et al (8). Direct involvement of the underlying chest wall or skin with oedema (including peau d'orange) or ulceration or satellite skin nodules confined to the same breast or dimpling or nipple retraction connote locally advanced breast tumour (9).…”

A Note on the Cost-Benefit Problem in Screening for Breast Cancer

“…For P, values between two and four per 1000 are reasonable and we shall take P = .004 for subsequent calculations. »Detection rates"« of this magnitude') are reported from the Breast Cancer Screening Program of H.I.P., the Health Insurance Plan of Greater New York [27]. by WOLFE [28] 'from Detroit and from our own institution by GRIESBACH and EADS [14].…”

“…by WOLFE [28] 'from Detroit and from our own institution by GRIESBACH and EADS [14]. In these rates are included cases found by palpation only, palpation being a routine part of the screening program [27] or executed only at the discretion of clinicians in the multiphasic screening program [14]. We shall assume that s = 5 and m = 15 do include palpation.…”

“…From the randomized trial of H.I.P. [27] we take the information that the percentage of patients with axillary nodes is 30 in the screening and 54 in the control group. Similar figures (27 versus 60) are reported by DOWDY et al [8].…”

“…casting the problem into the framework of a stochastic disease progression model, agree with the former [16] that a direct comparison of the survival experience of a screened group with that of an unscreened one (for instance, in terms of the traditional 5-year survival rate) is inappropriate because of the »lead-time« gained by the screened group. Depending on model assumptions, lead-time estimates range from one year (VENET et al [27]) to 2.4 years [29] on the same data, namely the randomized screening trial of H.I.P. [27].…”