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Routine Clinical Breast Examination Is a Low-Yield Practice Among Women at High Risk of Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

For women at increased risk of breast cancer, the National Comprehensive Cancer Network (NCCN) guidelines recommend clinical encounters every 6–12 months. While screening mammography has corresponded with a relative risk reduction in breast cancer mortality of approximately 20%, evidence validating clinical breast examination (CBE) as an efficacious screening modality is deficient. Our study aimed to assess the conventional merit of regular CBE for breast cancer detection among individuals at increased risk of breast cancer development.

Methods

Women > 18 years with documented high-risk encounters at Corewell Health West from 1 January 2018 to 31 December 22 were retrospectively reviewed. High-risk criteria included genetic predisposition, 5-year (> 1.7%) or lifetime (> 20%) Tyrer–Cuzick and/or Gail Model risk estimations, thoracic radiotherapy before age 30 years, lobular carcinoma in-situ, or atypical hyperplasia. Patients with a history of breast cancer or bilateral prophylactic mastectomy prior to 2018 were excluded.

Results

Of the 9171 cumulative high-risk encounters among 2493 women, only one breast cancer was detected by CBE. CBE resulted in 1 (0.04%) cancer diagnosis compared with 30 (1.2%) detected on screening imaging and 10 (0.4%) self-reported. Of the 30 image-detected cancers, 28 (93.3%) had no detectable clinical findings at the time of preoperative consultation. Self-reported and CBE-detected cancers were more likely to be of higher clinical stage compared with imaging-detected malignancies.

Conclusions

The role of routine CBE as a cancer detection modality in the high-risk patient population appears to be limited. Telemedicine can be offered to individuals who have completed screening imaging but are unable to commit and/or are inconvenienced by in-person high-risk breast cancer assessments.

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References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7–33. https://doi.org/10.3322/caac.21708.

    Article  PubMed  Google Scholar 

  2. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer Screening and Diagnosis V.32023. https://www.nccn.org/guidelines/guidelines-detail?category=2&id=1421. Accessed March 1, 2024.

  3. American Cancer Society. Cancer facts & figures 2024. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2024/2024-cancer-facts-and-figures-acs.pdf. Accessed March 1, 2024.

  4. Miller KD, Nogueira L, Devasia T, et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022;72(5):409–36. https://doi.org/10.3322/caac.21731.

    Article  PubMed  Google Scholar 

  5. Gøtzsche PC, Jørgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2013;2013(6):CD001877. https://doi.org/10.1002/14651858.CD001877.pub5.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Tabár L, Dean PB, Chen TH, et al. The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening. Cancer. 2019;125(4):515–23. https://doi.org/10.1002/cncr.31840.

    Article  PubMed  Google Scholar 

  7. Marmot MG, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M. The benefits and harms of breast cancer screening: an independent review. Br J Cancer. 2013;108(11):2205–40. https://doi.org/10.1038/bjc.2013.177.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Autier P, Héry C, Haukka J, Boniol M, Byrnes G. Advanced breast cancer and breast cancer mortality in randomized controlled trials on mammography screening. J Clin Oncol. 2009;27(35):5919–23. https://doi.org/10.1200/JCO.2009.22.7041.

    Article  PubMed  Google Scholar 

  9. Qaseem A, Lin JS, Mustafa RA, et al. Screening for breast cancer in average-risk women: a guidance statement from the American College of Physicians [published correction appears in Ann Intern Med. 2023 Apr;176(4):584]. Ann Intern Med. 2019;170(8):547–60. https://doi.org/10.7326/M18-2147.

    Article  PubMed  Google Scholar 

  10. Oeffinger KC, Fontham ET, Etzioni R, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society [published correction appears in JAMA. 2016 Apr 5;315(13):1406]. JAMA. 2015;314(15):1599–614. https://doi.org/10.1001/jama.2015.12783.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Klarenbach S, Sims-Jones N, Lewin G, et al. Recommendations on screening for breast cancer in women aged 40–74 years who are not at increased risk for breast cancer. CMAJ. 2018;190(49):E1441–51. https://doi.org/10.1503/cmaj.180463.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Anderson BO, Bevers TB, Carlson RW. Clinical breast examination and breast cancer screening guideline. JAMA. 2016;315(13):1403–4. https://doi.org/10.1001/jama.2016.0686.

    Article  PubMed  Google Scholar 

  13. Myers ER, Moorman P, Gierisch JM, et al. Benefits and harms of breast cancer screening: a systematic review [published correction appears in JAMA. 2016 Apr 5;315(13):1406]. JAMA. 2015;314(15):1615–34. https://doi.org/10.1001/jama.2015.13183.

    Article  CAS  PubMed  Google Scholar 

  14. American Cancer Society Inc. Recommendations for the early detection of breast cancer. Published 19 December 2023. https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html. Accessed 1 March 2024.

  15. Menes TS, Coster D, Coster D, Shenhar-Tsarfaty S. Contribution of clinical breast exam to cancer detection in women participating in a modern screening program. BMC Womens Health. 2021;21(1):368. https://doi.org/10.1186/s12905-021-01507-x.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Barton MB, Harris R, Fletcher SW. The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA. 1999;282(13):1270–80. https://doi.org/10.1001/jama.282.13.1270.

    Article  CAS  PubMed  Google Scholar 

  17. Oestreicher N, White E, Lehman CD, Mandelson MT, Porter PL, Taplin SH. Predictors of sensitivity of clinical breast examination (CBE). Breast Cancer Res Treat. 2002;76(1):73–81. https://doi.org/10.1023/a:1020280623807.

    Article  CAS  PubMed  Google Scholar 

  18. Mann RM, Hooley R, Barr RG, Moy L. Novel approaches to screening for breast cancer. Radiology. 2020;297(2):266–85. https://doi.org/10.1148/radiol.2020200172.

    Article  PubMed  Google Scholar 

  19. Shaver J. The state of telehealth before and after the COVID-19 pandemic. Prim Care. 2022;49(4):517–30. https://doi.org/10.1016/j.pop.2022.04.002.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Shaffer KM, Turner KL, Siwik C, et al. Digital health and telehealth in cancer care: a sco** review of reviews. Lancet Digit Health. 2023;5(5):e316–27. https://doi.org/10.1016/S2589-7500(23)00049-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgement

The authors thank the Scholarly Activity Support Department for assistance with statistical analysis.

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Authors and Affiliations

  1. Michigan State University College of Human Medicine, Grand Rapids, MI, USA

    Tien Hua BA, Sergio Mendoza BS, Morgan McCririe-Balcom BA, G. Paul Wright MD & Jessica Thompson MD

  2. General Surgery Residency, Corewell Health West, Grand Rapids, MI, USA

    Jesse Kelley MD

  3. Division of Cancer Health, Corewell Health West, Grand Rapids, MI, USA

    G. Paul Wright MD & Jessica Thompson MD

Authors
  1. Tien Hua BA
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  2. Sergio Mendoza BS
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  3. Morgan McCririe-Balcom BA
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  4. Jesse Kelley MD
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  6. Jessica Thompson MD
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Correspondence to Tien Hua BA.

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Hua, T., Mendoza, S., McCririe-Balcom, M. et al. Routine Clinical Breast Examination Is a Low-Yield Practice Among Women at High Risk of Breast Cancer. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15702-1

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