NEW YORK, Oct 06 (Reuters Health) -- Performed properly, clinical examination of the breast can detect at least 50% of asymptomatic cancers in women over the age of 40 and may help reduce mortality from breast cancer in older women who undergo screening, researchers report in the October 6th issue of The Journal of the American Medical Association.
The investigators also suggest that detection of early breast cancer can be improved if healthcare professionals are taught to perform the exam in a standardized way.
Dr. Mary B. Barton and colleagues from Harvard Medical School, Boston, Massachusetts, and from the University of North Carolina in Chapel Hill, collected data from 110 articles published between 1966 and 1997 on the effectiveness of clinical breast examination (CBE) as a screening tool to detect breast cancer and what the best technique might be. According to the data analyzed, investigators found that clinical examination of the breast by itself detected anywhere between 3% and 45% of breast cancers missed on mammography.
Although it was difficult to determine precisely how much clinical breast examination alone contributes to breast cancer detection, the authors note that in every study, "CBE contributed to cancer detection independently of mammography," they state. In one large trial, for example, mortality rates in women with breast cancer at 7 years were similar among those who had undergone clinical breast examination and those who had undergone both clinical examination of the breast and screening mammography.
These results suggest that "mammography may not offer mortality rate advantages over a careful screening CBE, at least for women in their 50s," Barton and colleagues state. The investigators also suggest that if standardized examination techniques were more widely used, more breast cancers might be detected.
Correct breast examination technique includes spending at least 3 minutes examining each breast, proper placement and movement of the fingers in a specific pattern, and the correct positioning of the patient.
"Although the clinical breast examination is widely recommended and practiced, technique varies greatly. More studies are needed to determine whether the standard techniques can be taught and how effective they can be in improving the precision and accuracy of the clinical breast examination," said Barton in a statement issued by the Harvard Pilgrim Health Care Foundation, which funded the study.
