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April 5, 2000

Clinical Breast Examination for Detecting Breast Cancer—Reply

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

In Reply: Drs Goodson and Moore illustrate how changes in a cut point for a positive test result alters test LR. Different examiners and different definitions are likely to produce different cut points and LRs. When a surgeon determines that a patient needs a breast biopsy, the LR is high (as in the HIP study). A screening CBE by a primary care physician that results in a nonroutine follow-up (eg, a repeat physical examination, ultrasonographic examination, or referral to a surgeon who may or may not recommend biopsy) is, not surprisingly, associated with a substantially lower LR. The situation is analogous to comparing the LR of an abnormal mammogram result with a breast imaging reporting and data system1 (the standard classification adopted for mammography) reading of 5—"highly suggestive of malignancy"—to the lower LR of a reading in categories 3, 4, or 5.2 Because of these problems, we suggested in our article that common definitions and categories for abnormalities found on CBE should be developed, as has been done for mammography.

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