Amidst all of the questions about prostate cancer screening today, let's not lose sight of the Journal of the National Cancer Insititute article on questions about breast exams in the doctor's office.
The question: do clinical breast exams - docs doing breast exams - improve the accuracy of what mammograms contribute to breast cancer screening?
The implication: The benefit in increased sensitivity from adding clinical breast exams to mammography needs to be weighed against the potential risks and costs of further follow-up due to false-positive results as well as the anxiety associated with additional diagnostic evaluations.
Results: Mammography sensitivity was similar between centers that offered clinical breast exams (CBE) and those that did not. However, women without cancer who were screened at regional cancer centers or affiliated centers that offered clinical breast exams had a higher false-positive rate than women screened at affiliated centers that offered only mammography.
Low-tech primary care interventions that can decrease the burden of cancer in women are extremely appealing. At the same time, ineffective practices, or those with even marginal net benefit, would be a disservice to our patients. More answers are needed on the role of CBE in breast cancer screening before definitive recommendations for or against its use can be made. While we wait for those answers, the data presented by Chiarelli et al. suggest that CBE must be done well if it is to be done at all, with the acknowledgment that overall referrals and false-positive results will increase.