title: Utility of Clinical Breast Examinations in Detecting Local-Regional Breast Events After Breast-Conservation in Women with a Personal History of High-Risk Breast Cancer.
abstract: Although breast cancer follow-up guidelines emphasize the importance of clinical examinations, prior studies suggest a small fraction of local-regional events occurring after breast conservation are detected by examination alone. Our objective was to examine how local-regional events are detected in a contemporary, national cohort of high-risk breast cancer survivors.
  
  
  
  A stage-stratified sample of stage II/III breast cancer patients diagnosed in 2006-2007 (n = 11,099) were identified from 1217 facilities within the National Cancer Data Base. Additional data on local-regional and distant breast events, method of event detection, imaging received, and mortality were collected. We further limited the cohort to patients with breast conservation (n = 4854). Summary statistics describe local-regional event rates and detection method.
  
  
  
  Local-regional events were detected in 5.5 % (n = 265) of patients. Eighty-three percent were ipsilateral or contralateral in-breast events, and 17 % occurred within ipsilateral lymph nodes. Forty-eight percent of local-regional events were detected on asymptomatic breast imaging, 29 % by patients, and 10 % on clinical examination. Overall, 0.5 % of the 4854 patients had a local-regional event detected on examination. Examinations detected a higher proportion of lymph node events (8/45) compared with in-breast events (18/220). No factors were associated with method of event detection.
  
  
  
  Clinical examinations, as an adjunct to screening mammography, have a modest effect on local-regional event detection. This contradicts current belief that examinations are a critical adjunct to mammographic screening. These findings can help to streamline follow-up care, potentially improving follow-up efficiency and quality.
authors: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Neuman@surgery.wisc.edu.|University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Neuman@surgery.wisc.edu.
authors: Heather B
authors: HB
authors: Neuman
authors: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: Jessica R
authors: JR
authors: Schumacher
authors: ACS Clinical Research Program, American College of Surgeons, Chicago, IL, USA.
authors: Amanda B
authors: AB
authors: Francescatti
authors: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: Taiwo
authors: T
authors: Adesoye
authors: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors: Stephen B
authors: SB
authors: Edge
authors: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: Elizabeth S
authors: ES
authors: Burnside
authors: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.|University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.|Population Health Science, University of Wisconsin, Madison, WI, USA.
authors: David J
authors: DJ
authors: Vanness
authors: Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA.
authors: Menggang
authors: M
authors: Yu
authors: Population Health Science, University of Wisconsin, Madison, WI, USA.
authors: Yajuan
authors: Y
authors: Si
authors: Department of Surgery, Wright State University, Dayton, OH, USA.
authors: Dan
authors: D
authors: McKellar
authors: American College of Surgeons Cancer Programs, Chicago, IL, USA.
authors: David P
authors: DP
authors: Winchester
authors: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.|University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: Caprice C
authors: CC
authors: Greenberg
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D016504:Breast Self-Examination; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008327:Mammography; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D010808:Physical Examination; D012042:Registries; D012307:Risk Factors