Findings From 752 081 Clinical Breast Examinations Reported to a National Screening Program From 1995 Through 1998

Bobo, Janet Kay; Lee, Nancy C.; Thames, Sandra F.

doi:10.1093/jnci/92.12.971

Cited by 143 publications

(118 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the quality of CBE in a community setting is likely to be lower. 16,17 The sensitivity of CBE supplemented with mammography is also high, which contradicts some of the criticisms of mammography quality in the CNBSS. 18 However, part of the observed high detection rate at screening is explained by an estimated 24 -29% higher breast cancer incidence rate in the trial compared to the average Canadian rate.…”

Section: Discussionmentioning

confidence: 95%

Mammography benefit in the Canadian National Breast Screening Study‐2: A model evaluation

Rijnsburger

Oortmarssen

Boer

et al. 2004

Intl Journal of Cancer

View full text Add to dashboard Cite

The CNBSS-2 among women aged 50 -59 did not show any significant difference in breast cancer mortality between a control arm screened annually by CBE and a study arm screened by CBE and mammography. Because of this design, the benefit of screening compared to no screening could not be evaluated. We therefore conducted a modeling effort to estimate the benefit of mammography or CBE compared to no screening. We incorporated demographic, epidemiologic and screening characteristics of the CNBSS-2 in MISCAN. Stage-specific sensitivities of CBE, with and without mammography, and breast cancer incidence rate in the trial were estimated by comparing observed trial data with model predictions. We predicted the number of breast cancer deaths for both study arms of the CNBSS-2 and in the absence of screening, assuming improvement in prognosis by early detection. We estimated a 24 -29% higher breast cancer incidence rate in the CNBSS-2 than the average Canadian rate. Key words: breast cancer; screening; mortality; mammography; clinical breast examination; Canadian National Breast Screening Study-2Several randomized controlled trials have assessed the efficacy of mammography screening at reducing breast cancer mortality. An updated overview of 4 Swedish randomized trials showed breast cancer mortality reductions in invited women of 16% (50 -59 years) and 33% (60 -69 years). 1 However, in a Cochrane review, the authors found smaller breast cancer mortality reductions in 2 so-called medium-quality trials. 2 The Malmö trial and the CNBSS-2 showed 20% (Ն55 years) and 3% (50 -59 years) breast cancer mortality reductions after 7 years of follow-up.The CNBSS-2, however, was designed to evaluate the efficacy of annual mammography over and above annual CBE. The 7-and 13-year follow-up results of this randomized trial did not show a significant difference in mortality from breast cancer between the 2 groups, even though high detection rates were found. 3,4 Because the control arm was screened, no estimations of mammography benefit compared to no screening could be made, as is available from other mammography trials, nor any estimate of the benefit of CBE screening.Here, we provide a quantitative interpretation of the CNBSS-2 results, using a MISCAN model evaluation of the trial. MISCAN is a microsimulation program, which has been successfully applied in the evaluation of different cancer-screening programs. [5][6][7] The main purpose of the model evaluation is to show what can be learned about breast cancer screening for women aged 50 and above and about the natural history of the disease from the CNBSS-2 in relation to what we know from other breast cancerscreening trials. The evaluation addresses 2 specific questions: (i) Can any explanations, resulting from the model evaluation, be given for the observed equal breast cancer mortality in both study arms of the CNBSS-2? (ii) What percentage of breast cancer mortality reduction by mammography screening compared to no screening can we estimate for the CNBSS-2? MATERIAL AND METHODS CNB...

show abstract

Section: Discussionmentioning

confidence: 95%

Mammography benefit in the Canadian National Breast Screening Study‐2: A model evaluation

Rijnsburger

Oortmarssen

Boer

et al. 2004

Intl Journal of Cancer

View full text Add to dashboard Cite

show abstract

“…One recent large-scale observational study showed that among women aged 50-69, CBE contributes to cancer detection, with roughly 0.8 cancers per 1000 screens detected by CBE alone (positive CBE and benign or missing mammography results). 16 However, early detection and prognostic outcomes were not evaluated. 16 Furthermore, CBE in that setting may not have optimised the use of the clinical examination to identify subtle signs of breast cancer.…”

mentioning

confidence: 99%

“…16 However, early detection and prognostic outcomes were not evaluated. 16 Furthermore, CBE in that setting may not have optimised the use of the clinical examination to identify subtle signs of breast cancer. 17 Although clear abnormal clinical ndings including discrete palpable masses, bloody or serous nipple discharge, nipple or areolar scaliness, or skin dimpling or retraction were assessed, subtler signs such as asymmetric thickening of the breast tissue or slight asymmetry of breast contour were not examined.…”

mentioning

confidence: 99%

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

et al. 2003

View full text Add to dashboard Cite

Setting: Four Canadian organised breast cancer screening programmes. Methods: Women aged 50-69 receiving dual screening (CBE and mammography) (n=300,303) between 1996 and 1998 were followed up between screen and diagnosis. Outcomes assessed by mode of detection (CBE alone, mammography alone, or both CBE and mammography) included referral rate, positive predictive value, pathological features of tumours (size, nodal status, morphology), and cancer detection rates overall and for small cancers (<10 mm or node-negative). Heterogeneity in ndings across programmes was also assessed. Results:On rst versus subsequent screen, CBE alone resulted in 28.5-36.7% of referrals, and 4.6-5.9% of cancers compared with 52.6-60.1% of referrals and 60.0-64.3% of cancers for mammography alone. Among cancers detected by CBE, 83.6-88.6% were also detected by mammography, whereas for mammographically detected cancers only 31.7-37.2% were also detected by CBE. On average, CBE increased the rate of detection of small invasive cancers by 2-6% over rates if mammography was the sole detection method. Without CBE, programmes would be missing three cancers for every 10,000 screens and 3-10 small invasive cancers in every 100,000 screens.

show abstract

“…In community based studies, without the implementation of standard breast exam guidelines, CBE detected about 5 % of cancers that were not visible on mammography. 8 The Canadian National …”

mentioning

confidence: 99%

“…In community based studies, without the implementation of standard breast exam guidelines, CBE detected about 5 % of cancers that were not visible on mammography. 8 The Canadian National Published online February 23, 2013 Breast Cancer Study-2 investigated the effects of mammography alone compared to careful standardized clinical breast examination plus mammography, and found that breast cancer mortality was the same in both groups after 13 years of follow-up. 9 Cancers revealed by CBE are more aggressive compared to those found on mammogram.…”

mentioning

confidence: 99%

The Clinical Breast Exam: A Skill that Should Not Be Abandoned

Bryan

Snyder

2013

J GEN INTERN MED

View full text Add to dashboard Cite

The clinical breast exam (CBE) is an important tool in the care of women. However, the utility of the screening CBE has been called into question. This article discusses the importance of the CBE as a physical diagnosis tool. Recommendations regarding screening with CBE are reviewed, and evidence surrounding breast cancer screening using CBE is briefly summarized. Clinicians should strive to provide high quality CBEs as part of the general clinical exam for women, particularly those who present with breast complaints, and for patients who choose to have CBE screening. In conclusion, there is a role for the CBE in the care of women, and clinicians should be proficient at performing these exams. Simulation teaching technologies are now available at Department of Veteran Affairs (VA) facilities to enable clinicians to improve their CBE skills. T he clinical breast exam (CBE) is an important tool in the care of women. It is utilized for the evaluation of breast complaints and, more controversially, in breast cancer screening. The Department of Veteran Affairs (VA) Women's Health Services Office has recently coordinated the distribution of breast exam simulation equipment to VA facilities in order to enhance CBE competency training for VA providers. Since the utility of the screening CBE has been called into question, 1 the issue may be raised as to whether this training is pertinent. The following summary will provide rationale that the CBE is an important physical diagnosis skill that should not be discarded, and that simulation equipment is a helpful tool in training clinicians.Clearly, the CBE is required for the evaluation of patients with breast complaints, particularly those with a breast lump. In one study of primary care clinics, 11 % of women complaining of a breast lump and 4 % of women with any breast complaint were found to have a malignancy. 2 In addition, a significant number of patients with breast cancer present with a palpable breast mass. Haakinson et al. 3 reported that 34 % of women with invasive breast cancer initially presented with a palpable lesion. 13 % of the women with a palpable breast mass who were found to have invasive cancer had a normal mammogram within the previous year. Likewise, a large study of diagnostic mammograms reported that the sensitivity of mammography in women with a self-reported breast lump was 87.3 %. 4 This suggests that approximately 13 % of clinically evident breast cancers may be missed by mammography imaging. Therefore, identifying these tumors by palpation is a pertinent clinical issue, and providers should be proficient at discerning abnormal breast findings.The more divisive issue is whether the clinical breast exam should be used in conjunction with mammography for breast cancer screening in asymptomatic patients. The US Preventive Services Task Force (USPSTF) states that there is insufficient evidence to recommend for or against routine screening with the CBE. 1 However, the American Cancer Society 5 and the American College of Obstetricians and Gynecologist...

show abstract

Findings From 752 081 Clinical Breast Examinations Reported to a National Screening Program From 1995 Through 1998

Abstract: CBEs performed in community-based screening programs can detect breast cancers as effectively as CBEs performed in clinical trials and may modestly improve early-detection campaigns.

Cited by 143 publications

References 28 publications

Mammography benefit in the Canadian National Breast Screening Study‐2: A model evaluation

Mammography benefit in the Canadian National Breast Screening Study‐2: A model evaluation

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

The Clinical Breast Exam: A Skill that Should Not Be Abandoned

Contact Info

Product

Resources

About