title: Is clinical breast examination important for breast cancer detection?
abstract: BACKGROUND
  Screening clinical breast examination (cbe) is controversial; the use of cbe is declining not only as a screening tool, but also as a diagnostic tool. In the present study, we aimed to assess the value of cbe in breast cancer detection in a tertiary care centre for breast diseases.
  
  
  METHODS
  This retrospective study of all breast cancers diagnosed between July 1999 and December 2010 at our centre categorized cases according to the mean of detection (cbe, mammography, or both). A cbe was considered "abnormal" in the presence of a mass, nipple discharge, skin or nipple retraction, edema, erythema, peau d'orange, or ulcers.
  
  
  RESULTS
  During the study period, a complete dataset was available for 6333 treated primary breast cancers. Cancer types were ductal carcinoma in situ (15.3%), invasive ductal carcinoma (75.7%), invasive lobular carcinoma (9.0%), or others (2.2%). Of the 6333 cancers, 36.5% (n = 2312) were detected by mammography alone, 54.8% (n = 3470) by mammography and cbe, and 8.7% (n = 551) by physician-performed cbe alone (or 5.3% if considering ultrasonography). Invasive tumours diagnosed by cbe alone were more often triple-negative, her2-positive, node-positive, and larger than those diagnosed by mammography alone (p < 0.05).
  
  
  CONCLUSIONS
  A significant number of cancers would have been missed if cbe had not been performed. Compared with cancers detected by mammography alone, those detected by cbe had more aggressive features. Clinical breast examination is a very low-cost test that could improve the detection of breast cancer and could prompt breast ultrasonography in the case of a negative mammogram.
authors.affiliation: Centre des maladies du sein Deschênes-Fabia, chu de Québec-Université Laval, Quebec City, QC.; chu de Québec-Université Laval, Quebec City, QC.; Department of Surgery, Cancer Research Centre, Université Laval, Quebec City, QC.; Oncology Research Unit, Centre de Recherche du chu de Québec-Université Laval, Quebec City, QC.
authors.forename: L
authors.initials: L
authors.lastname: Provencher
authors.affiliation: Centre des maladies du sein Deschênes-Fabia, chu de Québec-Université Laval, Quebec City, QC.; chu de Québec-Université Laval, Quebec City, QC.; Oncology Research Unit, Centre de Recherche du chu de Québec-Université Laval, Quebec City, QC.
authors.forename: J C
authors.initials: JC
authors.lastname: Hogue
authors.affiliation: Centre des maladies du sein Deschênes-Fabia, chu de Québec-Université Laval, Quebec City, QC.; chu de Québec-Université Laval, Quebec City, QC.; Department of Surgery, Cancer Research Centre, Université Laval, Quebec City, QC.; Oncology Research Unit, Centre de Recherche du chu de Québec-Université Laval, Quebec City, QC.
authors.forename: C
authors.initials: C
authors.lastname: Desbiens
authors.affiliation: Centre des maladies du sein Deschênes-Fabia, chu de Québec-Université Laval, Quebec City, QC.; chu de Québec-Université Laval, Quebec City, QC.; Department of Surgery, Cancer Research Centre, Université Laval, Quebec City, QC.; Oncology Research Unit, Centre de Recherche du chu de Québec-Université Laval, Quebec City, QC.
authors.forename: B
authors.initials: B
authors.lastname: Poirier
authors.affiliation: Centre des maladies du sein Deschênes-Fabia, chu de Québec-Université Laval, Quebec City, QC.; chu de Québec-Université Laval, Quebec City, QC.; Department of Surgery, Cancer Research Centre, Université Laval, Quebec City, QC.; Oncology Research Unit, Centre de Recherche du chu de Québec-Université Laval, Quebec City, QC.
authors.forename: E
authors.initials: E
authors.lastname: Poirier
authors.affiliation: Centre des maladies du sein Deschênes-Fabia, chu de Québec-Université Laval, Quebec City, QC.; chu de Québec-Université Laval, Quebec City, QC.; Department of Surgery, Cancer Research Centre, Université Laval, Quebec City, QC.; Oncology Research Unit, Centre de Recherche du chu de Québec-Université Laval, Quebec City, QC.
authors.forename: D
authors.initials: D
authors.lastname: Boudreau
authors.affiliation: Centre des maladies du sein Deschênes-Fabia, chu de Québec-Université Laval, Quebec City, QC.; chu de Québec-Université Laval, Quebec City, QC.; Oncology Research Unit, Centre de Recherche du chu de Québec-Université Laval, Quebec City, QC.; Department of Family Medicine, Cancer Research Centre, Université Laval, Quebec City, QC.
authors.forename: M
authors.initials: M
authors.lastname: Joyal
authors.affiliation: Centre des maladies du sein Deschênes-Fabia, chu de Québec-Université Laval, Quebec City, QC.; Oncology Research Unit, Centre de Recherche du chu de Québec-Université Laval, Quebec City, QC.; Department of Social and Preventive Medicine, Cancer Research Centre, Université Laval, Quebec City, QC.
authors.forename: C
authors.initials: C
authors.lastname: Diorio
authors.affiliation: Centre des maladies du sein Deschênes-Fabia, chu de Québec-Université Laval, Quebec City, QC.; chu de Québec-Université Laval, Quebec City, QC.; Oncology Research Unit, Centre de Recherche du chu de Québec-Université Laval, Quebec City, QC.; Department of Medical Imaging, Cancer Research Centre, Université Laval, Quebec City, QC.
authors.forename: N
authors.initials: N
authors.lastname: Duchesne
authors.affiliation: Centre des maladies du sein Deschênes-Fabia, chu de Québec-Université Laval, Quebec City, QC.; chu de Québec-Université Laval, Quebec City, QC.; Oncology Research Unit, Centre de Recherche du chu de Québec-Université Laval, Quebec City, QC.; Department of Family Medicine, Cancer Research Centre, Université Laval, Quebec City, QC.; Public Health Research Unit, Centre de Recherche du chu de Québec-Université Laval, Quebec City, QC.
authors.forename: J
authors.initials: J
authors.lastname: Chiquette
keywords: Breast cancer; clinical examination; mammography; palpable breast masses; screening; ultrasonography