Does This Patient Have Breast Cancer?
JAMAPublished 6 October 1999
Mary B. Barton, Russell Harris, Suzanne W. Fletcher
Citations372
SJR quartileQ1
SJR score5.35
SNIP10.71
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TL;DR
Indirect evidence supports the effectiveness of CBE in screening for breast cancer, and professional and lay examiners improved their sensitivity on silicone breast models after being taught this technique.
Abstract
Indirect evidence supports the effectiveness of CBE in screening for breast cancer. Although the screening clinical examination by itself does not rule out disease, the high specificity of certain abnormal findings greatly increases the probability of breast cancer.
Keywords
MedicineBiochemistry, Genetics and Molecular Biology
JNCI Journal of the National Cancer InstituteProjecting Individualized Probabilities of Developing Breast Cancer for White Females Who Are Being Examined Annually
3,327 Citations1989M. H. Gail, Louise A. Brinton +5 more
To assist in medical counseling, a method to estimate the chance that a woman with given age and risk factors will develop breast cancer over a specified interval is presented and individualized breast cancer probabilities are calculated.
New England Journal of MedicineRisk Factors for Breast Cancer in Women with Proliferative Breast Disease
1,852 Citations1985William D. Dupont, David L. Page
It is demonstrated that the majority of women who undergo breast biopsy for benign disease are not at increased risk of cancer, however, patients with a clinically meaningful elevation in cancer risk can be identified on the basis of atypical hyperplasia and a family history of breast cancer.
The LancetREDUCTION IN MORTALITY FROM BREAST CANCER AFTER MASS SCREENING WITH MAMMOGRAPHY
1,795 Citations1985Làszló Tabár, Ahmed Z. Gad +10 more
7 years after the start of the study the excess of stage I cancers in the study group largely outweighs the deficit of advanced cancers, and the results to the end of 1984 show a 31% reduction in mortality from breast cancer and a 25% reduced in the rate of stage II or more advanced breast cancers.
PubMedGenetic linkage analysis in familial breast and ovarian cancer: results from 214 families. The Breast Cancer Linkage Consortium.
1,253 Citations1993Douglas F. Easton, D. Timothy Bishop +2 more
The results suggest that a gene(s) on chromosome 17q accounts for the majority of families in which both early-onset breast cancer and ovarian cancer occur but that other genes predisposing to breast cancer exist.
JAMAEfficacy of Screening Mammography
1,063 Citations1995Karla Kerlikowske, Deborah Grady +3 more
Screening mammography may be effective in reducing breast cancer mortality in women aged 40 to 49 years after 10 to 12 years of follow-up, but the same benefit could probably be achieved by beginning screening at menopause or 50 years of age.
New England Journal of MedicineTen-Year Risk of False Positive Screening Mammograms and Clinical Breast Examinations
1,055 Citations1998Joann G. Elmore, Mary B. Barton +4 more
Over 10 years, one third of women screened had an abnormal test result that required additional evaluation, even though no breast cancer was present, and Physicians should educate women about the risk of a false positive result from a screening test for breast cancer.
BMJMammographic screening and mortality from breast cancer: the Malmö mammographic screening trial.
926 Citations1988Ingvar Andersson, Knut Aspegren +7 more
JNCI Journal of the National Cancer InstituteThe Lifetime Risk of Developing Breast Cancer
635 Citations1993Eric J. Feuer, Lap‐Ming Wun +4 more
A revised method for calculating estimates of the lifetime risk of developing breast cancer and a conditional risk estimate over the short term (10 or 20 years) may be more reliable.
JAMAA Prospective Study of Benign Breast Disease and the Risk of Breast Cancer
506 Citations1992Stephanie J. London
The LancetREDUCTION OF BREAST CANCER MORTALITY THROUGH MASS SCREENING WITH MODERN MAMMOGRAPHY
498 Citations1984A.L.M. Verbeek, Roland Holland +4 more
Since 1975 four rounds of screening with modern mammography for breast cancer have been carried out among 30 000 Nijmegen women born before 1940, showing that the odds ratio of screened vs unscreened subjects among women who died from breast cancer compared with women who did not, was 0.48.
New England Journal of MedicineLong-Term Risk of Breast Cancer in Women with Fibroadenoma
495 Citations1994William D. Dupont, David L. Page +5 more
Fibroadenoma is a long-term risk factor for breast cancer and the risk is increased in women with complex fibroadenomas, proliferative disease, or a family history of breast cancer.
The LancetEdinburgh trial of screening for breast cancer: mortality at seven years
450 Citations1990Alison Huggins
Between 1979 and 1981, 45,130 women in Edinburgh aged 45-64 were entered into a randomised trial of breast cancer screening by mammography and clinical examination, which showed a mortality reduction of 17% in women aged 50 years and over.
JNCI Journal of the National Cancer InstituteRecent Trends in U.S. Breast Cancer Incidence, Survival, and Mortality Rates
430 Citations1996K. C. Chu, Robert E. Tarone +5 more
Statistical modeling indicates that the recent drop in breast cancer mortality is too rapid to be explained only by the increased use of mammography; likewise, there has been no equivalent dramatic increase in survival rates that would implicate therapy alone.
JNCI MonographsBenefit of Screening Mammography in Women Aged 40-49: A New Meta-Analysis of Randomized Controlled Trials
421 Citations1997R. Edward Hendrick, Robert A. Smith +2 more
Meta-analysis including the most recent follow-up data from all eight RCTs involving women aged 40-49 at entry demonstrates for the first time a statistically significant mortality reduction due to regular screening mammography in women of this age group.
CancerCancer incidence and mortality, 1973-1995
400 Citations1998Phyllis A. Wingo, Lynn Ries +3 more
The American Cancer Society, the National Cancer Institute, and the Centers for Disease Control and Prevention including the National Center for Health Statistics will produce an annual "Report Card" to the nation on progress related to cancer prevention and control in the U.S.
PubMedPrevalence and contribution of BRCA1 mutations in breast cancer and ovarian cancer: results from three U.S. population-based case-control studies of ovarian cancer.
383 Citations1997Alice S. Whittemore, Gail Gong +1 more
Investigation of the familial risks of cancers of the breast and ovary, using data pooled from three population-based case-control studies of ovarian cancer, suggests that rare mutations account for all the observed aggregation of breast cancer and ovarian cancer in these families.
The LancetEVALUATION OF SCREENING FOR BREAST CANCER IN A NON-RANDOMISED STUDY (THE DOM PROJECT) BY MEANS OF A CASE-CONTROL STUDY
377 Citations1984H.J.A. Collette, Jan J. Rombach +2 more
In 1974 a non-randomised study of the effect of mass screening by physical examination and xeromammography on mortality from breast cancer was started, and of the 20 555 eligible women in the city of Utrecht born between 1911 and 1925, 14 796 attended for screening.
Journal of Epidemiology & Community HealthThe Swedish two county trial of mammographic screening for breast cancer: recent results and calculation of benefit.
362 Citations1989Làszló Tabár, G Fagerberg +2 more
Results show an increasingly significant deficit in deaths from breast cancer among the 77,092 women invited to screening relative to the 56,000 not invited, with no significant difference between the effects of screening in the two counties, and results remain the same when adjusted for age.
CA A Cancer Journal for CliniciansSurvival Experience in The Breast Cancer Detection Demonstration Project
306 Citations1987Herbert Seidman, Steven K. Gelb +3 more
Very high survival rates have been observed in four through 11 years of follow‐up in 4,240 women with a histologically confirmed diagnosis of breast cancer in the Breast Cancer Detection Demonstration Project (BCDDP).
American Journal of RoentgenologyCanadian National Breast Screening Study.
291 Citations1990A. B. Miller, Cornelia J. Baines +1 more
American Journal of RoentgenologyAnalysis of parenchymal density on mammograms in 1353 women 25-79 years old.
256 Citations1996Paul C. Stomper, David D'Souza +2 more
A significant percentage of women who were 25-39 years old had predominantly fatty breast tissue that should not impede selective mammographic screening or diagnostic efforts in this age group, and the frequency and distribution of dense mammograms were determined.
Annals of Internal MedicineDuctal Carcinoma in Situ of the Breast
245 Citations1997Rafaël Fonseca, Lynn C. Hartmann +4 more
The findings of the autopsy studies suggest that incidental DCIS of uncertain clinical relevance is not common, and the rate of increase in incidence has been higher for DCIS than for any other type of breast cancer.
New England Journal of MedicineFibrocystic Disease of the Breast — A Nondisease?
220 Citations1982Susan M. Love, Rebecca Gelman +1 more
The LancetFIRST RESULTS ON MORTALITY REDUCTION IN THE UK TRIAL OF EARLY DETECTION OF BREAST CANCER
212 Citations1988UKTRIALOFEARLYDETECTIONOFBRE
New England Journal of MedicineDifferential Contributions of<i>BRCA1</i>and<i>BRCA2</i>to Early-Onset Breast Cancer
210 Citations1997Michael Krainer, Sandra Silva-Arrieta +10 more
Among young women with breast cancer, there are BRCA2 mutations that cause truncation of the extreme C terminus of the protein and that may be functionally silent, along with definite truncating mutations, which contribute to fewer cases of breast cancer among young women than do mutations in BRCa1.
International Journal of CancerA case‐control study of the efficacy of a non‐randomized breast cancer screening program in florence (Italy)
196 Citations1986Domenico Palli, Marco Rosselli Del Turco +5 more
In a rural area near Florence a population‐based screening program for breast cancer was started in 1970, offering a mammography test every 2.5 years to all women between 40 and 70 years of age, a case‐control study has been carried out comparing the screening history of all women who died from breast cancer in this area in the years 1977–1984 with that of a matched group of living controls.
Annals of Internal MedicineBreast Symptoms among Women Enrolled in a Health Maintenance Organization: Frequency, Evaluation, and Outcome
181 Citations1999Mary B. Barton, Joann G. Elmore +1 more
This study studied women who presented with breast symptoms to primary care clinicians in a large health maintenance organization [HMO] in the northeastern United States and determined how often symptoms lead to a diagnosis of breast cancer.
JAMALikelihood ratios for modern screening mammography. Risk of breast cancer based on age and mammographic interpretation
165 Citations1996Karla Kerlikowske
New England Journal of MedicineEvaluation of a Palpable Breast Mass
155 Citations1992Jane F. Desforges, William L. Donegan
With intensive public education about breast cancer and the growing acceptance of routine self-examination of the breasts, particularly by young women, an increasing number of women can be expected to seek consultation for the evaluation of breast masses.
PubMedEffect of breast self-examination techniques on the risk of death from breast cancer.
146 Citations1997Bart J. Harvey, Anthony B. Miller +2 more
The results, obtained with the use of prospectively collected data, suggest that the performance of specific BSE components may reduce the risk of death from breast cancer.
CancerDiagnostic reliability of combined physical examination, mammography, and fine-needle puncture (“triple-test”) in breast tumors: A prospective study
143 Citations1987Christian L. Hermansen, Hans Skovgaard Poulsen +5 more
A prospective study of 622 consecutively registered patients with 650 breast tumors was performed to appraise the reliability of combined physical examination, mammography, and fine‐needle puncture (triple test) in the preoperative diagnosis of such tumors.
JAMAPhysicians' Abilities to Detect Lumps in Silicone Breast Models
134 Citations1985Suzanne W. Fletcher
Modest detection rates and wide variation suggest breast lump detection can be improved among physicians, and adequate search duration may be important for high detection rates.
TechnometricsMeWAnalysis by the Confidence Profile Method: The Statistical Synthesis of Evidence
120 Citations1993Russell V. Lenth
Part 1 Examples of problems - vignettes: setting up the analysis - formulating the problem organizing the evidence types of evidence biases summarizing the evidence influence diagrams models for combining evidence introduction to Bayes' Formula.
CancerImproved detection of human breast lesions following experimental training
118 Citations1980Deborah C. Hall, Calvin K. Adams +4 more
There is a need for a more complex model for training discrimination between normal nodularity and breast lesions and confidence in correct detections was greater than confidence in false positives.
PubMedManagement of nipple discharge.
116 Citations1994Hüseyin Gülay, Seymen Bora +3 more
Patients presenting with nipple discharge should undergo biopsy or subareolar exploration based on the presence or absence of a palpable tumor, and the patients in whom no clinical findings could be detected should have follow-up evaluation at regular intervals.
CancerPhysical examination. Its role as a single screening modality in the Canadian national breast screening study
113 Citations1990Cornelia J. Baines, Anthony B. Miller +1 more
The results support the conclusion that physical examination of the breasts by trained nurses is a useful component in screening for breast cancer.
CancerMammography and palpable cancer of the breast
82 Citations1988Stanley Edeiken
It is concluded that biopsy should be performed on every undiagnosed, persistent, dominant mass without consideration of the mammogram when there is a persistent mass, especially in younger women.
Annual Review of Public HealthMammography Utilization, Public Health Impact, and Cost-Effectiveness in the United States
81 Citations1993Emily White, Nicole Urban +1 more
The LancetVALIDITY OF CLINICAL EXAMINATION AND MAMMOGRAPHY AS SCREENING TESTS FOR BREAST CANCER
80 Citations1975J Chamberlain, Pauline Rogers +4 more
Early results suggest that as a screening test mammography compares favourably with clinical examination, but both tests are necessary if many false negatives are to be avoided.
CancerMammography and clinical examination in mass screening for cancer of the breast
74 Citations1967Philip Strax, Louis Venet +2 more
Periodic screening for cancer of the breast using mammography as well as clinical examination is being conducted by the Health Insurance Plan in a large random sample of women aged 40 to 64 years, with significant results from the first screening examination.
American Journal of Preventive MedicineImproving Physicians’ and Nurses’ Clinical Breast Examination: A Randomized Controlled Trial
71 Citations1991H. Sharon Campbell, Suzanne W. Fletcher +3 more
The results show health professionals can be taught successfully to improve their clinical breast examination accuracy and skills and the effect of training on specificity in the clinical setting is evaluated.
Tumori JournalDifferential Diagnosis of Axillary Masses
69 Citations1996Jurandyr Moreira de Andrade, Heitor Ricardo Cosiski Marana +4 more
Chest X-ray and bilateral mammography are useful when the cause of the mass cannot be determined by taking a detailed history of neoplastic or infectious antecedents, by careful physical examination of the skin of the arms, trunk and neck, or by palpation of the breasts and thyroid.
Academic Press eBooksFAST PRO : software for meta-analysis by the confidence profile method
69 Citations1992David M. Eddy, Victor Hasselblad
Part 1 Using "FAST*PRO": getting started an example basic functions creating profiles for experiments, and the confidence profile method formulating the assessment problem and the evidence biases models for combining evidence indirect evidence sensitivity analysis and research design.
CancerIncreased proficiency of search in breast self-examination
65 Citations1986Kathryn J. Saunders, Carol Pilgrim +1 more
Results indicate that the VS pattern is the pattern of choice for maximally effective BSE, and it produced more thorough coverage in all but nine comparisons.
JNCI Journal of the National Cancer InstituteDiagnostic Testing Following Screening Mammography in the Elderly
63 Citations1998H. Gilbert Welch, Elliott S. Fisher
Additional testing is a frequent consequence of screening mammography and may require a considerable period of time to come to closure, however, the need for additional testing is weakly predictive of cancer.
Journal of General Internal MedicineImproving clinical breast examination training in a medical school
62 Citations1993Carol Pilgrim, Carole Lannon +3 more
RadiologyPalpable solid breast masses: retrospective single- and multimodality evaluation of 201 lesions.
61 Citations1988Peter A. van Dam, M L Van Goethem +5 more
Use of four modalities increased the preoperative diagnostic true-positive rate to 0.97, with some decline in specificity, andMultimodality testing seems particularly beneficial in pre- and perimenopausal patients.
The LancetBreast screening: the case for physical examination without mammography
56 Citations1994Indraneel Mittra
The question the authors should be asking is not how to refine mammographic screening but whether they need it at all, because evidence suggests that physical examination (PE) is at least as effective in reducing mortality.
JNCI MonographsMammography Versus Clinical Examination of the Breasts
53 Citations1997Cornelia J. Baines, Anthony B. Miller
It is concluded that combining clinical breast examination with Mammography is desirable for women age 40-49 because mammography is less sensitive in younger than older women and careful training and monitoring are, however, as essential with clinical examiners as with mammographers.
British journal of surgeryClinical, radiological and cytological diagnosis of breast cancer in young women
53 Citations1989S. Ashley, G T Royle +5 more
It is indicated that cytological confirmation of apparently benign focal breast lesions in young women is essential, especially when these are managed conservatively, as well as Histology showed that there were fewer low grade tumours and fewer scirrhous tumours in this group of women aged over 35 years.
CancerAdequacies and inadequacies of breast examinations by physicians in mass screening
53 Citations1971L Venet, Philip Strax +2 more
The American Journal of SurgeryProspective evaluation of physical examination of the breast
49 Citations1981Norman F. Boyd, Heather J. Sutherland +4 more
Despite differences in the frequency with which each surgeon found abnormalities or masses, or recommended mammography or biopsy, the diagnostic accuracy of the surgeons was very similar, and most disagreements concerned the findings in patients who did not have breast cancer.
Perception & PsychophysicsLump detection in simulated human breasts
48 Citations1976Calvin K. Adams, Deborah C. Hall +6 more
Examination of breast models for the detection of lumps simulating cancer is a task amenable to experimental analysis and a significant correlation was found between the number of lumped detected and duration of trial.
Journal of General Internal MedicineHow do women compare with internal medicine residents in breast lump detection?
44 Citations1989Suzanne W. Fletcher, Michael O’Malley +2 more
Women’s and physicians’ breast examination accuracies differ, but for the two groups accuracies vary similary by lump characteristics and examination technique.
Academic MedicineTeaching medical students how to perform a clinical breast examination
44 Citations1994H. Sharon Campbell, Mary Eunice McBean +2 more
A randomized study to compare standardized and unstandardized methods of teaching clinical breast examinations and to determine whether trained non-medical women could teach as well as medical faculty.
PubMedEfficiency of palpation in clinical detection of breast cancer.
41 Citations1982Leo J. Mahoney, A Csima
Retraction in this series was not related to the size of the primary tumour but among the women with a cancerous breast lump was significantly more likely to be found in those over 44 years of age, being present in 52% of these women but only 10% of the younger women.
Perception & PsychophysicsMajor stimulus dimensions determining detection of simulated breast lesions
41 Citations1982H. S. Bloom, Eleanor L. Criswell +3 more
Physical parameters for realistic breast models and lumps to be used in training effective breast self-examination and breast lump detection are suggested.
Archives of SurgeryAccuracy of Combined Clinical-Mammographic-Cytologic Diagnosis of Dominant Breast Masses
35 Citations1990John Butler
The combined triad of physical, mammographic, and fine-needle aspiration cytologic examinations is highly accurate in the diagnosis of breast masses, and patients in whom all three examination results are benign can be safely observed, obviating the need for an open biopsy.
CancerPhysical examination of the breast
32 Citations1992David P. Winchester
Despite the increasing emphasis in physicians' use of screening mammography, primary care physicians continue to appropriately perform physical examination of the breast.
Clinical RadiologyThe accuracy of mammography alone and in combination with clinical examination and cytology in the detection of breast cancer
29 Citations1988David M. Hansell, Julie Cooke +1 more
The accuracy of mammography alone and in combination with clinical examination and aspiration cytology was assessed in 402 patients who attended the Early Diagnostic Unit of the Royal Marsden Hospital, London.
Journal of Epidemiology & Community HealthFurther evidence of benefits of a (non-randomised) breast cancer screening programme: the DOM project.
29 Citations1992H.J.A. Collette, F. de Waard +3 more
Early diagnosis of breast cancer by mammography reduces breast cancer mortality in women 50-64 years old at intake, making clear that the effect depends on the intensity of the programme.
European Journal of CancerInterval cancers and sensitivity in the screening centres of the UK trial of early detection of breast cancer
24 Citations1993Sue Moss, D Coleman +6 more
The incidence rates of interval cancers following a negative breast screen in two screening centres which offered women aged 45-64 annual screening by mammography and/or clinical examination are examined.
American Journal of RoentgenologyMammography in women with axillary lymphadenopathy and normal breasts on physical examination: value in detecting occult breast carcinoma.
23 Citations1992A. Jill Leibman, Marjorie B. Kossoff
The experience suggests that mammography is valuable in patients with normal breasts on physical examination who have primary carcinoma involving ipsilateral axillary lymph nodes and the procedure should be included in the diagnostic evaluation of patients with axillary adenopathy in order to detect the unusual case of occult breast carcinoma.
PubMedDiagnostic efficacy of the clinical-radiological-cytological triad in solid breast lumps: results of a second prospective study on 631 patients.
23 Citations1987S. Di Pietro, Giuseppe Fariselli +5 more
The systematic use of the diagnostic triad and the organizational platform allowed the clinicians to select malignant cases and plan inpatient/outpatient surgical treatment.
JNCI Journal of the National Cancer InstituteReport of NCI Ad Hoc Pathology Working Group To Review the Gross and Microscopic Findings of Breast Cancer Cases in the HIP Study (Health Insurance Plan of Greater New York)
22 Citations1977Louis B. Thomas, Lauren V. Ackerman +4 more
Journal of Behavioral MedicineEffects of certain training parameters on detection of simulated breast cancer
19 Citations1979Hester S. Stephenson, Calvin K. Adams +2 more
The results indicate the effectiveness of the training procedure for improving detection ability and suggest the need for a more complex model to determine more specifically the effects of the practice models employed.
PubMedManagement of lobular carcinoma in situ and ductal carcinoma in situ of the breast.
18 Citations1996Wood Wc
Therapeutic decisions involving the extent of surgical excision and the addition of irradiation are based on considerations of tumor size and grade and the patient's age.
Journal of Chronic DiseasesInter-observer error among surgeons and nurses in presymptomatic detection of breast disease
18 Citations1981Duncan C. Thomas, Walter O. Spitzer +1 more
Future studies to compare the performance of nurses or other allied health professionals with surgeons should, therefore, be designed to allow assessement of the reliability of the standard group.
Journal of General Internal MedicineLump detection is enhanced in silicone breast models simulating postmenopausal breast tissue
14 Citations1996Mary Mcdermott, Nancy C. Dolan +3 more
Gynecologic OncologyBreast cancer detection: Age-related significance of findings on physical exam and mammography
13 Citations1988H. G. Bender, H.-G. Schnürch +1 more
The relatively low positive predictive value of both PE and MG--particularly in the lower age groups--leads to an excessive rate of benign biopsies up to the age of 60.
Medical Entomology and ZoologyPhysical Diagnosis: Bedside Evaluation of Diagnosis and Function
13 Citations1994Janice L. Willms, Henry Schneiderman +1 more
PubMedPhysical examination of the breasts in screening for breast cancer.
10 Citations1992Cornelia J. Baines
If screening is introduced it should include both mammography and clinical examination of the breasts because the two complement one another and stringent quality control procedures are required for both modalities.
MaturitasAttempts to evaluate a non-randomized breast cancer screening programme (the ‘DOM-project’)
7 Citations1985H.J.A. Collette
Some long-term benefit was forecast by a case-control study--the odds ratio of dying from breast cancer among ever-screened women compared with that in never- screened women was 0.29 (95% confidence interval: 0.14-0.62).
Tumori JournalBreast Cancer Diagnosis under the Age of Forty Years
3 Citations1987Stefano Ciatto, Andrea Herd Smith +9 more
The authors criticize the aggressive policy of extensive biopsy recommendation based only on a dubious report on PE alone and stress the opportunity of the routine association of M and CYT to PE, since this combination seems to achieve a higher breast cancer detection rate even in this age group.
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