title: Contribution of clinical breast examination to mammography screening in the early detection of breast cancer.
abstract: OBJECTIVE
  As the benefit of clinical breast examination (CBE) over that of screening mammography alone in reducing breast cancer mortality is uncertain, it is informative to monitor its contribution to interim measures of effectiveness of a screening programme. Here, the contribution of CBE to screening mammography in the early detection of breast cancer was evaluated.
  
  
  METHODS
  Four Canadian organised breast cancer screening programmes.
  
  
  METHODS
  Women aged 50-69 receiving dual screening (CBE and mammography) (n = 300,303) between 1996 and 1998 were followed up between screen and diagnosis. Outcomes assessed by mode of detection (CBE alone, mammography alone, or both CBE and mammography) included referral rate, positive predictive value, pathological features of tumours (size, nodal status, morphology), and cancer detection rates overall and for small cancers (< or = 10 mm or node-negative). Heterogeneity in findings across programmes was also assessed.
  
  
  RESULTS
  On first versus subsequent screen, CBE alone resulted in 28.5-36.7% of referrals, and 4.6-5.9% of cancers compared with 52.6-60.1% of referrals and 60.0-64.3% of cancers for mammography alone. Among cancers detected by CBE, 83.6-88.6% were also detected by mammography, whereas for mammographically detected cancers only 31.7-37.2% were also detected by CBE. On average, CBE increased the rate of detection of small invasive cancers by 2-6% over rates if mammography was the sole detection method. Without CBE, programmes would be missing three cancers for every 10,000 screens and 3-10 small invasive cancers in every 100,000 screens.
  
  
  CONCLUSIONS
  Inclusion of CBE in an organised programme contributes minimally to early detection.
authors.affiliation: Screening and Early Detection, Chronic Disease Prevention Division, Centre for Chronic Disease Prevention and Control, Health Canada.
authors.forename: C
authors.initials: C
authors.lastname: Bancej
authors.forename: K
authors.initials: K
authors.lastname: Decker
authors.forename: A
authors.initials: A
authors.lastname: Chiarelli
authors.forename: M
authors.initials: M
authors.lastname: Harrison
authors.forename: D
authors.initials: D
authors.lastname: Turner
authors.forename: J
authors.initials: J
authors.lastname: Brisson
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000517:prevention & control; D002170:Canada / Q000453:epidemiology; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008403:Mass Screening / Q000379:methods*; D010173:Palpation / Q000379:methods / Q000592:standards*; D011187:Posture; D015203:Reproducibility of Results