Findings from 752081 clinical breast examinations reported to a national screening program from 1995 through 1998

Background and Methods: Mammography programs have received extensive study, but little is known about the outcome of clinical breast examinations (CBE s) performed in community settings. Consequently, we analyzed data from the National Breast and Cervical Cancer Early Detection Program on CBEs provid ed to low-income women from 1995 through 1998 and determined the percentage of CBEs considered to be abnormal, suspicious for cancer; the rates of can cer detection; and the sensitivity, specificity, and positive predictive va lue of CBEs. Results: We analyzed data from 752081 CBEs and found that 6.9% of all CBEs were coded abnormal, suspicious for cancer, and that 5.0 cance rs were detected per 1000 examinations (95% confidence interval [CI] = 4.9- 5.2), The values observed for sensitivity (58.8%) and specificity (93.4%) w ere comparable to those reported for the CBE component of clinical trials. The observed positive predictive value was 4.3%. About 74% of all records a lso reported mammography results. The cancer-detection rate among records r eporting an abnormal CBE and normal mammography was 7.4 cancers per 1000 re cords (95% CT = 6.3-8.4), When the CBE was normal but the mammography was a bnormal, the rate was 42.0 cancers per 1000 records (95% CI = 39.9-44.1), W hen both CBE and mammography results were abnormal, the rate was 170.3 canc ers per 1000 records (95% CT = 162.7-177.9), Cancer detection could not be attributed entirely to CBE or mammography on 38% of the records in the latt er subset because the tests were performed on the same day. Conclusion: CBE s performed in community-based screening programs can detect breast cancers as effectively as CBEs performed in clinical trials and may modestly impro ve early-detection campaigns.