The Incremental Contribution of Clinical Breast Examination to Invasive Cancer Detection in a Mammography Screening Program

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Abstract
OBJECTIVE. The objective of this study was to determine the potential added contribution of clinical breast examination (CBE) to invasive breast cancer detection in a mammography screening program, by categories of age and breast density.SUBJECTS AND METHODS. We prospectively followed 61,688 women aged 40 years or older who had undergone at least one screening examination with mammography and CBE between January 1, 1996, and December 31, 2000, for 1 year after their mammogram for invasive cancer. We computed the incremental sensitivity, specificity, and positive predictive value of CBE over mammography alone for combinations of age and breast density (predominantly fatty or dense).RESULTS. Mammography sensitivity was 78% and combined mammography–CBE sensitivity was 82%, thus CBE detected an additional 4% of invasive cancers. CBE detected a minority of invasive cancers compared with mammography for all age groups and all breast densities. Sensitivity increased from adding CBE to screening mammography for a...