Physical examination. Its role as a single screening modality in the Canadian national breast screening study

Abstract

Although often recommended as an important component in screening for breast cancer, physical examination of the breasts (PE) by medical professionals has not been well evaluated. The Canadian National Breast Screening Study (NBSS) permits estimation of sensitivity, specificity, and positive predictive value (PPV) of PE alone as performed by screen-examiners because 50% of the 89,835 NBSS participants did not receive mammography. There were 19,965 women aged from 50 to 59 years who were eligible to receive four or five annual PEs from 77 nurse-examiners, in 12 screen centers outside Quebec province and 58 physician-examiners in three screen centers in Quebec. The gold standard was histologically proven breast cancer. When a test was positive the participant was referred to the study surgeon for review. For screens one to five, sensitivity was 83, 71, 57, 83, and 77; specificity was 88, 94, 96, 96, and 96; and PPV was 3, 3, 4, 3, and 4, respectively. For 25,620 women aged 40 to 49 years who were eligible to receive only one PE, sensitivity was 71, specificity 84, and PPV 1.5. Using a binomial regression model, X2 for heterogeneity suggested there was no difference between nurse and physician examiners (P = 0.6879). Similar estimates made for the surgeons who performed 8914 reviews showed that sensitivity and PPV were higher than for the screen examiners and specificity was lower. These results support the conclusion that physical examination of the breasts by trained nurses is a useful component in screening for breast cancer.

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

“…It was primarily performed by specially trained nurse-examiners, who were closely monitored during the study. 14,15 High CBE sensitivities for larger tumors are plausible because of this intensive type of screening. However, the quality of CBE in a community setting is likely to be lower.…”

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

“…11,27,28 Based on our ndings, reliance exclusively on CBE would decrease referral rates at the expense of missing 41 cancers per 10,000 screen events that would have been detected by mammography, or 31 invasive cancers for every 10,000 screens. Others have found that CBE missed 41% of cancers.…”

Câncer na população feminina brasileira

“…Tais ações, incorporando o diagnóstico precoce do câncer de mama, dependeriam muito mais de um treinamento de pessoal qualificado para a detecção a partir do exame físico do que de tecnologia de alto custo. Estudos realizados no Canadá mostram que a sensibilidade do exame físico feito por profissional treinado para rastreamento das neoplasias mamárias em programas ampliados é superior à da mamografia 4 . Situações tais como a desarticulação entre os diversos níveis de assistência à saúde, ociosidade da rede pública, falta de programação e avaliação das ações impedem que qualquer programa assistencial ou preventivo possa ter melhores resultados.…”