title: Tumor size and detection in breast cancer: Self-examination and clinical breast examination are at their limit.
abstract: BACKGROUND
  This study investigates to what extent tumor detection methods in breast cancer have changed and how this has influenced tumor size at initial diagnosis.
  
  
  METHODS
  1054 breast carcinomas < or =5 cm, newly diagnosed between 1990 and 2006, were evaluated for the tumor detection methods used, namely self-detection (SD, n=568), clinical breast examination (CBE, n=212), and radiological breast examination (RBE, n=237), and their corresponding tumor sizes.
  
  
  RESULTS
  During the study period, the proportion of cases found by RBE increased (p<0.001), while median tumor size decreased (1990-1992: 22 mm; 2005/2006: 17 mm. Spearman rho=-0.12, p<0.001). Nevertheless, SD remained the most frequent method of tumor identification (2005/2006: 48.9%). Carcinomas found by RBE were smaller (median size: 12 mm) than those found by the other two detection forms (SD: 21 mm, CBE: 21 mm; p<0.001). Within the different methods, only in RBE was an appreciable decrease in the size of the detected tumors observed during the study period (Spearman rho=-0.14, p<0.001; SD: Spearman rho=-0.05, p=0.19; CBE: Spearman rho=-0.05, p=0.43).
  
  
  CONCLUSIONS
  Despite educational campaigns and high media coverage, the possibilities for improving the "classical" methods of tumor detection in breast cancer, self-detection and clinical breast examination, seem to be at their limit. The significant decrease in tumor size at time of detection observed in the last years is primarily only due to the increased use of breast imaging. Improved detection of smaller tumors may presumably be reached only by an increased use of radiological procedures.
authors.affiliation: University Hospital Basel, Department of Gynecology and Obstetrics, Spitalstrasse 21, CH-4031 Basel, Switzerland. ugueth@uhbs.ch
authors.forename: Uwe
authors.initials: U
authors.lastname: Güth
authors.forename: Dorothy Jane
authors.initials: DJ
authors.lastname: Huang
authors.forename: Marco
authors.initials: M
authors.lastname: Huber
authors.forename: Andreas
authors.initials: A
authors.lastname: Schötzau
authors.forename: Daniela
authors.initials: D
authors.lastname: Wruk
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Holzgreve
authors.forename: Edward
authors.initials: E
authors.lastname: Wight
authors.forename: Rosanna
authors.initials: R
authors.lastname: Zanetti-Dällenbach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis*; D016504:Breast Self-Examination; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D010808:Physical Examination; D016217:Ultrasonography, Mammary