Contribution of clinical breast examination to mammography screening in the early detection of XXXX .

@entity1 @entity5 @entity0
OBJECTIVES: As the benefit of clinical breast examination (CBE) over that of screening mammography alone in reducing @entity0 mortality is uncertain, it is informative to monitor its contribution to interim measures of effectiveness of a screening programme. Here, the contribution of CBE to screening mammography in the early detection of @entity0 was evaluated. SETTING: Four Canadian organised @entity0 screening programmes. METHODS: @entity1 aged 50-69 receiving dual screening (CBE and mammography) (n = 300,303) between 1996 and 1998 were followed up between screen and diagnosis. Outcomes assessed by mode of detection (CBE alone, mammography alone, or both CBE and mammography) included referral rate, positive predictive value, pathological features of @entity5 (size, nodal status, morphology), and @entity5 detection rates overall and for small @entity5 (< or = 10 mm or node-negative). Heterogeneity in findings across programmes was also assessed. RESULTS: On first versus subsequent screen, CBE alone resulted in 28.5-36.7% of referrals, and 4.6-5.9% of @entity5 compared with 52.6-60.1% of referrals and 60.0-64.3% of @entity5 for mammography alone. Among @entity5 detected by CBE, 83.6-88.6% were also detected by mammography, whereas for mammographically detected @entity5 only 31.7-37.2% were also detected by CBE. On average, CBE increased the rate of detection of small invasive @entity5 by 2-6% over rates if mammography was the sole detection method. Without CBE, programmes would be missing three @entity5 for every 10,000 screens and 3-10 small invasive @entity5 in every 100,000 screens. CONCLUSIONS: Inclusion of CBE in an organised programme contributes minimally to early detection.
