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April 5, 2000

Clinical Breast Examination for Detecting Breast Cancer

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(13a):1687-1689. doi:10.1001/jama.283.13.1685

To the Editor: We agree with Dr Barton and colleagues1 that there are few data to evaluate the clinical breast examination (CBE) as a clinical test. However, we believe the likelihood ratio (LR) they estimate for the presence of a mass in the breast is at least an order of magnitude too low.

The Health Insurance Plan of New York (HIP)2 data, which the authors cite as the reference for Table 6 in their article, is a report of results of 449 biopsies of screen-detected breast masses.3 In the HIP study, 20% of masses were malignant and, as Mushlin4 pointed out, none of the clinical characteristics of a mass, once a mass was identified, were sufficient to lower the probability of malignancy to below 10%. Since posterior probability=prior probability × LR, then it is also true that LR=posterior probability/prior probability; in this case, LR=20/0.35=57 for the presence of a mass.

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