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By Amy Norton
Friday, February 11, 2005
NEW YORK (Reuters Health) - Having a doctor examine the breasts for potential
signs of cancer may add little to the benefits of mammography screening, a large
study suggests.
Researchers found that among nearly 62,000 women age 40 or older, the
combination of mammography and a clinical breast exam detected only a small
number of additional breast cancers compared with mammography alone.
Although the clinical exam did help catch cancers in women with dense breast
tissue, in particular, it also put these women at greater risk of being told
they might have cancer when they did not.
However, the findings should not be interpreted as a recommendation against
clinical breast exams, according to the study's lead author.
"We're just trying to lay out the information for women," said Dr. Nina
Oestreicher, a researcher at Kaiser Permanente in Oakland, California.
"It's really up to women and their doctors to make the decision," she told
Reuters Health, noting that many factors, including a woman's personal risk of
breast cancer and her degree of concern about the disease, could influence the
choice to have regular clinical breast exams in addition to mammography.
Experts recommend that women at average risk of breast cancer have a mammogram
every one to two years starting at age 40. Though mammography is imperfect, it
is credited with reducing breast cancer death rates in a number of countries
where the test is routinely performed.
However, the value of also having regular clinical breast exams, in which a
doctor observes and feels the breasts for lumps and other abnormalities, has
been unclear.
The new study, published in the American Journal of Roentgenology, suggests that
much depends on the density of a woman's breasts. Oestreicher and her colleagues
found that clinical breast exams carried a greater benefit for women with more
dense breast tissue, compared with those with more fatty tissue.
Dense breasts contain more glandular and connective tissue than fat, making it
easier for tumors to be obscured on mammograms. So in some cases, palpating the
breast for lumps can catch a tumor missed on the imaging test.
On the flip side, study patients with dense breasts were also nearly twice as
likely to get a false-positive result from a clinical breast exam, which can
lead to unnecessary biopsies.
According to Oestreicher, women should discuss these pros and cons of clinical
breast exams with their doctors, then base their decisions on their own
circumstances. For example, she noted, a woman who is particularly concerned
about breast cancer may feel that the modest benefit of clinical breast exams is
worth the possibility of getting a false alarm.
Since women with denser breasts benefit more from clinical exams, it might be
helpful, Oestreicher said, for women to find out their breast density, which can
be determined when they have a mammogram.
The current study included 61,688 women who had undergone at least one screening
with mammography and a breast exam.
The researchers found that mammography detected 78 percent of the cancers in
these women, while breast exams were able to catch 21 percent. The addition of a
clinical exam to mammography picked up 25 cancer cases (4 percent) in addition
to those detected by mammography alone.
SOURCE: American Journal of Roentgenology, February 2005.
Source : 050225
http://www.nlm.nih.gov/medlineplus/news/fullstory_22921.html