Clinical breast examination in the diagnosis of breast cancer

The high specificity of certain abnormal findings in clinical breast examination appears to greatly increase the probability of breast cancer.

A systematic review was abstracted in DARE. No trial has compared clinical breast examination (CBE) with no screening. Mammography outperformed CBE in 3 out of 4 trials comparing sensitivities: the proportion of cancers detected by CBE alone ranged from 3.4% to 45%. On the basis of 3 RCTs and 3 non-randomised studies, the sensitivity of CBE is approximately 54% (95% CI 48 to 60) and according to 3 RCTs and 2 non-randomised studies the specificity is about 94% (95% CI 90 to 97). The pooled positive LR is 10.6 (95% CI 5.8 to 19.2; 3 RCTs and 1 non-randomised study), and the pooled negative LR is 0.47 (95% CI 0.40 to 0.56, 3 RCTs and 1 non-randomised study).

Comment: The quality of evidence is upgraded by large magnitude of effect. An overall view of the evidence suggests that carefully performed CBE detects cancers that are potentially curable.

Ədəbiyyat

1. Barton MB, Harris R, Fletcher SW. The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA 1999 Oct 6;282(13):1270-80.