Screening for Breast Cancer: How Useful Are Clinical Breast Examinations?

Is it really useful to perform clinical breast examinations (CBEs)? No one will dispute that a woman presenting to her physician with a self-detected breast lump is likely to receive such an examination before being referred for diagnostic mammography. But how useful is it for physicians to perform CBEs in a preventive or screening mode? If they actually believe the somewhat dubious assertion that “mammographic screening of women age 40 and over can reduce breast cancer deaths by at least 30 to 40 percent” (1), physicians surely must ask themselves why bother with fingers? In this issue of the Journal, Bobo et al. (2) report results of CBEs performed in the U.S. National Breast and Cervical Cancer Early Detection Program. They conclude that CBEs in community-based screening programs can detect breast cancer as effectively as those done under controlled protocols in clinical trials. What do we learn from their article? How compelling is their conclusion?