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Comment & Response
April 5, 2016

Clinical Breast Examination and Breast Cancer Screening Guideline—Reply

Author Affiliations
  • 1Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Louisiana State University School of Public Health, New Orleans
  • 3American Cancer Society, Atlanta, Georgia
JAMA. 2016;315(13):1404. doi:10.1001/jama.2016.0689

In Reply Dr Anderson and colleagues claim that the ACS breast cancer screening guideline overstepped the boundaries of evidence by no longer recommending routine CBE in average-risk women. The boundary that allegedly was crossed is that the effect of not doing CBE has never been studied. This logic stands the principle of evidence-based medicine on its head. If anything, the ACS has overstepped the boundaries of evidence for many years by retaining a legacy recommendation for routine CBE in the absence of evidence that it was associated with a reduction in breast cancer mortality. Although the associated rate of false-positive results was a consideration, the lack of evidence of efficacy and contribution to patient-important outcomes were the central factors in adopting the new recommendation.1 More than 30 years ago, there was persuasive evidence that CBE made an important contribution to the detection of breast cancer, principally because of the limitations of mammography sensitivity at that time, and perhaps because of the experience and skill of a generation of clinicians trained when CBE was the only method for detecting breast cancer earlier than a woman might report it herself. Neither is the case today.