An assessment of the influence of clinical breast examination reports on the interpretation of mammograms in a breast screening program.

Abstract

The population-based Ontario Breast Screening Program (OBSP) provides two-yearly screening by both nurse examiner clinical breast examination (CBE) and two-view mammography to women aged 50 to 69. CBE alone accounts for about 5% of cancer detection. The purpose of this study was to determine whether CBE information affects radiologists' interpretation of mammography. Interpretation was defined by 1) radiologists' referral rates for diagnostic evaluation and 2) radiologists' accuracy in distinguishing cancer from non-cancer on mammograms. Mammograms were obtained from women randomly selected from those screened in the OBSP between 1990 and 1992. Selection was stratified by whether or not the nurse examiner had independently referred for diagnostic evaluation. Additional women diagnosed with breast cancer were selected to increase the precision of the receiver-operating characteristic (ROC) curve. Each participating OBSP radiologist read a set of mammograms twice, approximately three weeks apart. The first reading was based on mammograms alone. At the second reading, the CBE report was included on the reporting form. Among 620 women referred by the nurse, radiologist referral rate increased from 37.7% to 40.8% (p = 0.079) when CBE information was available. Among the 637 not referred by the nurse, radiologist referral rate decreased from 29.8% to 25.6% (p = 0.005). There was little effect on the sensitivity and specificity of radiologist referral and the areas under the two ROC curves (with and without CBE information) were not significantly different (p = 0.571). Although there was some effect of CBE information on radiologists' pattern of referral, there was no effect on accuracy of cancer detection.

Triple Test Score for the Evaluation of Invasive Ductal and Lobular Breast Cancer

“…The palpability alone is not an independent indicator, the diameter of the lesion correlated to the nodal state could be evaluated [37]. Knowing the result of the physical examination will not improve the diagnostic sensitivity of mammography [38], but can be crucial in the cases of mammographically occult tumors [39]. Symptomless cases usually come to the front by installation of new ancillary diagnostic methods for example scinti-mammography or MRI in screening of the population with strong family history [40,41].…”

Original Paper: Contribution of clinical breast examination to mammography screening in the early detection of breast cancer

“…One previous study did nd such an effect to be slight, but it had no effect on the accuracy of cancer detection. 36 Other factors -for example, patient-related factors (breast volume) which could not be assessed -may affect the performance of CBE. We found that CBE plays a limited part in the early detection of breast cancer.…”

Use of clinical history affects accuracy of interpretive performance of screening mammography

“…Little is known about the process of interpretation such as how radiologists use clinical history in their interpretation of screening mammograms and whether this use affects accuracy. Prior research on the use of clinical history in mammography has revealed conflicting results, with two studies showing improvements in the accuracy of detection of breast cancer (12,13) and one showing no improvement (14). These prior studies were limited by small samples of radiologists (n=2–10) in some cases and use of test sets, which may not represent the use of clinical history in actual practice (12–14).…”

“…Prior research on the use of clinical history in mammography has revealed conflicting results, with two studies showing improvements in the accuracy of detection of breast cancer (12,13) and one showing no improvement (14). These prior studies were limited by small samples of radiologists (n=2–10) in some cases and use of test sets, which may not represent the use of clinical history in actual practice (12–14). In addition, the studies differed in the elements of the clinical history that they examined, such as patient age or results of prior clinical breast exam.…”