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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: Dr Barton and colleagues1 conclude that a well-conducted CBE can detect at least 50% of asymptomatic cancers. I believe this conclusion, although technically correct, is deceiving.

The authors base their findings on 6 published studies: 3 conducted in the 1980s, 2 from the 1970s, and 1 from the 1960s. At the time of these studies, most of the women had never had a previous screening mammogram, had not undergone regular screening mammography, or, by today's standards, had received technically inferior mammograms. Only 2 of the 6 studies were performed in the United States. Many studies, including those cited by Barton et al, have demonstrated that approximately 15% of subsequently proven breast cancers are not identified by screening mammography. Therefore, if CBE were performed today in the United States among women who presumably were also undergoing regular screening mammography, it would identify only those 15% of cancers missed by mammography, plus the small additional number of tumors that had grown sufficiently to become apparent in the interval since the last mammographic examination.

Barton  MBHarris  RFletcher  SW Does this patient have breast cancer? the screening clinical breast examination: should it be done? how?  JAMA. 1999;282:1270-1280.Google Scholar