Breast Exams vs. Mammograms
Since I seem to be on a roll with information about the value of mammograms in screening, I thought I would share this article from the Journal of the National Cancer Institute. It compares the false positive rate of lumps found in clinical breast exam vs those identified by mammography. Here is a quote from the article:
Daniel B. Kopans, MD, director of the Breast Imaging Division at Massachusetts General Hospital in Boston, argued that only mammography has been proven to save lives, and that randomized trials are needed todetermine if breast examination does too.
"The only breast cancer screening test that has been shown to significantly decrease the death rate from breast cancer in randomized, controlled trials ... is mammography," Kopans said. "Those of us who developed the field of breast imaging recognized the importance of standardizing the technique, monitoring outcomes, and adjusting our approaches as we learned more and more about breast evaluation. I strongly< urge this approach be applied to [clinical breast examination]."
Freya Schnabel, MD, director of breast surgery at New York University, was more supportive of clinical exams. "I cannot imagine that anyone could advocate abandoning clinical breast exams, even in a screened population," she said. "It's clear that the pickup rate is low when patients are well screened, but superficial and central lesions are frequently missed on mammography, and young women with dense breasts represent a specific population where there is a substantial false negative rate for mammography, making clinical exam particularly important." She added, "As to the false positives on exam, many are resolved with simple, quick, relatively painless needle biopsies -- not such a big price to pay."
The bottom line continues to be that mammograms are our most valuable screening tool, but that clinical breast exams are important, too. Although the importance of self breast exams is controversial, I continue to advocate that we all do them--don't see any reason not to add this tool to our supply (especially since I discovered my first breast cancer that way). For some women at high risk for breast cancer, the addition of annual breast MRIs, staggered with yearly mammograms, is important.
If you want to read the whole article, here is the link: