From the Guidelines
Clinical breast examinations (CBEs) are not necessary for breast cancer screening in average-risk women of all ages, as the potential harms outweigh the benefits, according to the American College of Physicians guidance statement 1.
Key Points
- The American College of Physicians recommends against using CBE to screen for breast cancer in average-risk women of all ages, citing a lack of evidence for a mortality benefit and potential harms such as overdiagnosis and false-positive results leading to overtreatment 1.
- CBE can result in harms, including overdiagnosis and false-positive results leading to overtreatment, and takes about 5 to 10 minutes to do—time that could be devoted to health care interventions of greater proven net benefit 1.
- The guidance statement suggests that mammography is the preferred screening method for breast cancer, and that CBE is not recommended if mammography is available 1.
Recommendations
- Average-risk women should discuss their individual risk factors and screening options with their healthcare provider to determine the best approach for their circumstances.
- Mammography is recommended as the primary screening method for breast cancer, with the frequency and starting age of screening depending on individual risk factors and guidelines from reputable organizations such as the American College of Physicians and the U.S. Preventive Services Task Force 1.
Considerations
- The decision to use CBE or other screening methods should be based on individual patient factors, including risk factors, preferences, and values, as well as the potential benefits and harms of each approach 1.
- Healthcare providers should prioritize evidence-based screening methods and avoid using CBE as a primary screening tool for breast cancer in average-risk women, unless there are specific individual circumstances that warrant its use 1.
From the Research
Clinical Breast Examinations (CBEs) Necessity
- The necessity of clinical breast examinations (CBEs) is a topic of debate among medical professionals, with some studies suggesting that their role in breast cancer detection is limited 2.
- A study published in the Annals of Surgical Oncology found that among women at high risk of breast cancer, CBE resulted in only one cancer diagnosis, compared to 30 cancers detected through screening imaging and 10 self-reported cases 2.
- The American College of Radiology (ACR) recommends annual screening mammography for women at average risk, starting at age 40, and earlier and/or more intensive screening for women at higher-than-average risk 3.
- For women at high risk, the ACR recommends supplemental screening with breast MRI, in addition to annual mammography 3.
Breast Cancer Screening Recommendations
- The European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies support mammography for population-based screening, which has been shown to reduce breast cancer mortality 4.
- Biennial screening mammography is recommended for average-risk women aged 50-69 years, with extension to ages 40-45 and 70-74 years considered a lower priority 4.
- Digital breast tomosynthesis is expected to become the standard for routine mammography in the screening setting in the near future 4.
- Dedicated pathways for high-risk women, offering breast MRI according to national or international guidelines, are encouraged 4.
Risk Assessment and Symptomatic Women
- A case-control study using electronic records found that breast lump, breast pain, nipple retraction, and nipple discharge were significantly associated with breast cancer in symptomatic women in primary care 5.
- The positive predictive value (PPV) of breast cancer with a breast lump was found to be 4.8% in women aged 40-49 years, rising to 48% in women aged over 70 years 5.
- Current referral practice is supported by the findings, but the low likelihood of cancer for non-lump symptoms means that investigation for possible cancer is recommended at a more liberal risk threshold than for other cancers 5.