title: The accuracy of midwives' clinical breast examination in detection of breast lumps.
abstract: BACKGROUND
  Screen-detected breast cancers are usually diagnosed at earlier stages. Therefore, countries with limited resources are recommended to implement clinical breast examination (CBE) as a screening method in conjunction with mammography. Since there are so many limitations to performance of CBE by surgeons in the health system and CBE by midwives is more feasible, this study was conducted to test the agreement of CBE by midwives and surgeons.
  
  
  METHODS
  One thousand and twenty seven patients with no personal history of breast cancer received breast physical examination by both a midwife and a surgeon and designed forms including patients' general information, cause of referral and abnormal physical findings were completed for each patient.
  
  
  RESULTS
  The inter-observer agreement (kappa) for mass detection was 36 % (95% CI= 31% to 41%), indicating a "fair" agreement exists between the midwife's and the surgeon's physical examination. Sensitivity, specificity, positive and negative predictive values of "midwife's physical examination" to detect abnormal breast masses in comparison to "surgeon's physical examination" as the gold standard were 75, 67, 48, and 87 percent respectively.
  
  
  CONCLUSIONS
  The results of this study do not justify the replacement of general surgeons by midwives in the health care system as the first examiner for clinical breast screening. Decisions about this issue need more comprehensive studies considering cost-effectiveness and training procedures.
authors.affiliation: Department of Surgery, Imam Hospital, Tehran University of Medical Sciences, Toohid Sq., Tehran, Iran. akaviani@sina.tums.ac.ir
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kaviani
authors.forename: Bahram
authors.initials: B
authors.lastname: Delavar
authors.forename: Maryam
authors.initials: M
authors.lastname: Noparast
authors.forename: Zinat
authors.initials: Z
authors.lastname: Hatmi
authors.forename: Massoome
authors.initials: M
authors.lastname: Najafi
authors.forename: Shahpar
authors.initials: S
authors.lastname: Haghighat
authors.forename: Mina
authors.initials: M
authors.lastname: Majd
mesh_terms: D000328:Adult; D000368:Aged; D001941:Breast Diseases / Q000175:diagnosis*; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D013502:General Surgery; D006801:Humans; D007492:Iran; D008875:Middle Aged; D008880:Midwifery; D015588:Observer Variation; D010808:Physical Examination; D011237:Predictive Value of Tests; D015203:Reproducibility of Results