title: Clinical and self breast examination remain important in the era of modern screening.
abstract: BACKGROUND
  Breast cancer screening recommendations are in flux. We reviewed the methods of detecting newly diagnosed breast neoplasms at our institution.
  
  
  METHODS
  A retrospective review of patients stratified by age was performed to compare mammography with self- (SBE) and clinical (CBE) breast examination methods of cancer detection from 2005 to 2009.
  
  
  RESULTS
  We identified 782 patients. Patients aged <50 years were more likely to present with palpable disease (P < 0.001). Overall, 75% of patients had a mammogram within 24 months. There was a higher incidence of Tis tumors and lower incidence of T1 tumors if patients had mammography performed within 12 months versus 13-24 months (P < 0.01); tumor size, hormonal status, and lymph node (LN) status were comparable between these two groups. Patients diagnosed by SBE/CBE who had mammography performed within 12 months versus 13-24 months did not differ statistically according to tumor characteristics. In the screened cohort (mammography within 24 months), the majority of patients (64%) were diagnosed by mammography. Cancers detected by SBE/CBE were larger tumors (2.4 vs. 1.3 cm), higher grade, more frequently ER- (29 vs. 16%), triple-negative (21 vs. 10%), and lymph node-positive (39 vs. 18%; all P ≤ 0.01). There were no statistically significant differences in tumor size, T stage, or hormonal status in patients who had analog versus digital mammography.
  
  
  CONCLUSIONS
  Whereas the majority of patients had image-detected breast cancer, a significant number of image-screened patients presented with palpable disease, which were more aggressive cancers. Until imaging techniques are refined, SBE and CBE remain important for breast cancer diagnosis.
authors.affiliation: Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Ma
authors.forename: Amylou
authors.initials: A
authors.lastname: Dueck
authors.forename: Richard
authors.initials: R
authors.lastname: Gray
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: Marina
authors.initials: M
authors.lastname: Giurescu
authors.forename: Roxanne
authors.initials: R
authors.lastname: Lorans
authors.forename: Victor
authors.initials: V
authors.lastname: Pizzitola
authors.forename: Barbara
authors.initials: B
authors.lastname: Pockaj
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control*; D016504:Breast Self-Examination / Q000706:statistics & numerical data; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data*; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010808:Physical Examination / Q000706:statistics & numerical data*; D012189:Retrospective Studies