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Breast Imaging: Kimberly N. Feigin, Delia M. Keating, Patricia M. Telford, and Michael A. Cohen Clinical Breast Examination in a Comprehensive Breast Cancer Screening Program: Contribution and Cost Radiology 2006; 240: 650-655 [Abstract] [Full text] [PDF]

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The contribution of clinical examination in breast cancer screening

Robin Wilson, MD   (20 November 2006)

The contribution of clinical examination in breast cancer screening 20 November 2006
Robin Wilson, MD, Radiologist Nottingham Breast Institute Send letter to journal: Re: The contribution of clinical examination in breast cancer screening robin.wilson{at}nuh.nhs.uk Robin Wilson, MD	Editor In their article (1), Feigin et al conclude that clinical examination of the breast is complementary to mammography for detecting breast cancer through screening (increased detection of 3%). This conclusion somewhat misses the point. The purpose of breast screening is to reduce mortality from breast cancer through early detection. As the authors discuss, they have no way of assessing from their data the effectiveness of clinical examination with respect to any mortality effect or life years saved. The small amount of pathologic data included in this report suggests that the overall mortality benefit is likely to have been very small. Are the authors able to put their conclusions in better context by providing as much detail as possible about the pathologic features of the 14 tumors found by means of clinical examination only, such as size, histologic grade, and lymph node stage? Without this information, no conclusions whatsoever can be drawn regarding any additional benefit of detecting extra breast cancers by means of clinical examination. Reference 1. Feigin KN, Keating DM, Telford PM, Cohen MA. Clinical breast examination in a comprehensive breast cancer screening program: contribution and cost. Radiology 2006;240:650-655. Dr Feigin and colleagues respond: We thank Dr Wilson for his comments, and we agree that “the purpose of breast screening is to reduce mortality from breast cancer through early detection.” Our study was not designed to determine the effect of clinical breast examination (CBE) on mortality, nor meant to necessarily advocate CBE as a screening tool. Despite that performing CBE in a screening setting may or may not contribute to mortality reduction, it is a practice that is currently widely advocated by medical professionals and societies, including the American College of Radiology. We have attempted simply to provide practitioners with an estimate of the number of CBE-detected cancers they may expect to encounter in an asymptomatic population and an estimate of the cost of performing CBE in association with screening mammography.