title: A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year.
abstract: BACKGROUND
  Although mammography is the gold standard for breast cancer screening, clinical breast examination (CBE) and self breast examination (SBE) are important adjuncts whose utility has been questioned.
  
  
  METHODS
  A retrospective review of invasive breast cancer patients from 2000 to 2008 was performed. We compared 3 groups: breast cancer detected by (1) imaging only (nonpalpable) or palpable mass with a normal mammogram (2) ≥ 1 year (mammogram ≥ 1 year) or (3) <1 year (mammogram <1 year).
  
  
  RESULTS
  Of 1,222 women, presentation included 67% nonpalpable, 21% mammogram ≥ 1 year, and 13% mammogram <1 year. Patients presenting with palpable masses on SBE or CBE even with a normal mammogram within 1 year tended to have more aggressive tumors (larger size, lymph node positive, and triple-negative disease) resulting in more aggressive therapy (a higher mastectomy rate and a greater likelihood of chemotherapy).
  
  
  CONCLUSIONS
  A significant number of women present with palpable breast cancer within 1 year of a normal mammogram, many with an aggressive cancer. Therefore, we continue to advocate SBE and CBE for breast cancer screening.
authors.affiliation: Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA.
authors.forename: Danielle J
authors.initials: DJ
authors.lastname: Haakinson
authors.forename: Chee-Chee H
authors.initials: CC
authors.lastname: Stucky
authors.forename: Amylou C
authors.initials: AC
authors.lastname: Dueck
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: Heidi A
authors.initials: HA
authors.lastname: Apsey
authors.forename: Barbara
authors.initials: B
authors.lastname: Pockaj
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D016504:Breast Self-Examination; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D010173:Palpation
chemical_list: D014408:Biomarkers, Tumor