Clinical breast examination: practical recommendations for optimizing performance and reporting.
Clinical breast examination (CBE) seeks to detect breast abnormalities or evaluate patient reports of symptoms to find palpable breast cancers at an earlier stage of progression. Treatment options for earlier-stage cancers are generally more numerous, include less toxic alternatives, and are usually more effective than treatments for later-stage cancers. For average-risk women aged 40 and younger, earlier detection of palpable tumors identified by CBE can lead to earlier therapy. After age 40, when mammography is recommended, CBE is regarded as an adjunct to mammography. Recent debate, however, has questioned the contributions of CBE to the detection of breast cancer in asymptomatic women and particularly to improved survival and reduced mortality rates. Clinicians remain widely divided about the level of evidence supporting CBE and their confidence in the examination. Yet, CBE is practiced extensively in the United States and continues to be recommended by many leading health organizations. It is in this context that this report provides a brief review of evidence for CBE's role in the earlier detection of breast cancer, highlights current practice issues, and presents recommendations that, when implemented, could contribute to greater standardization of the practice and reporting of CBE. These recommendations may also lead to improved evidence of the nature and extent of CBE's contribution to the earlier detection of breast cancer.
Saslow
Debbie
D
American Cancer Society, Atlanta, Georgia, USA.
Hannan
Judy
J
Osuch
Janet
J
Alciati
Marianne H
MH
Baines
Cornelia
C
Barton
Mary
M
Bobo
Janet Kay
JK
Coleman
Cathy
C
Dolan
Mary
M
Gaumer
Ginny
G
Kopans
Daniel
D
Kutner
Susan
S
Lane
Dorothy S
DS
Lawson
Herschel
H
Meissner
Helen
H
Moorman
Candace
C
Pennypacker
Henry
H
Pierce
Peggy
P
Sciandra
Eva
E
Smith
Robert
R
Coates
Ralph
R
D001941:Breast Diseases / Q000175:diagnosis*; D001943:Breast Neoplasms / Q000175:diagnosis*; D004501:Education, Medical; D005260:Female; D006801:Humans; D008487:Medical History Taking; D010808:Physical Examination / Q000379:methods* / Q000592:standards*; D014481:United States