Effectiveness of self-examination, palpation, and mammography for the early detection of breast cancer: First results of the Munich field study

Objective: We evaluated the effectiveness of self-examination, palpation by a physician, and mammography for the early detection of breast cancer. Methods: Over a 2-year period all new cases of breast cancer in the Munich region (2.3 million inhabitants) were recorded for a population-based field study of health care. We analyzed the reported use of the three methods an d associations with prognostic factors, particularly TNM stage. Results: Data on detection techniques were available for 1319 of 2489 patie nts. Of these 1319 patients, 56% examined their breasts regularly and 54% p articipated in early detection. Both methods were used more by younger than by older women. Participation in early detection was associated with age a nd self-examination but not with family risk. No protective effects of diff erent combinations of the examination methods were found for women younger than 50 years. For patients older than 50 years the pT distribution in the mammography group (67.2% pT1, 20.8% pT2, 1.6 % pT3, 1.0 % pT4 tumors) was m ore favorable than that with the other modalities. The estimated reduction in 10-year mortality was 45 %. In this age group both palpation (52.6% pT1, 40.8% pT2, 5.3% pT3, 0% pT4) and self-examination (39.8% pT1, 39.2% pT2, 8 .5% pT3, 9.7% pT4) favorably influenced the stage distribution as compared with patients using no early detection; measures. In a multivariate analysi s, mammography with or without self-examination (OR 0.14 and 0.07, respecti vely) and palpation with self-examination (OR 0.19) were associated with fa vorable stage distribution whereas palpation alone (OR 0.19) and self-exami nation alone (OR 0.77) were not. Conclusions: All three methods for early detection of breast cancer contrib ute to reduced mortality. Mammography cannot be replaced by self-examinatio n and palpation in patients older than 50 years, but self-examination and p alpation should be used in addition to mammography in this age group.