Jiang H, Walter SD, Brown P, Raina P, Chiarelli AM. Estimation of the benefit and harms of including clinical breast examination in an organized breast screening program.
Breast 2018;
43:105-112. [PMID:
30544057 DOI:
10.1016/j.breast.2018.11.012]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND
There is controversy about the value of clinical breast examination (CBE) in addition to mammography for breast screening. The study investigates the associations between risk factors such as mammographic density, hormone therapy use and family history and the effectiveness of screening mammography with or without CBE.
METHODS
The cohort consists of women 50-69 years old screened at the Ontario Breast Screening Program. The associations of the risk factors were investigated using a joint logistic regression model that accommodates the partially unobserved disease status, clustered data structures, individual risk factors, and the dependence between true and false detection.
RESULTS
Having high mammographic density, a first degree relative with breast cancer and using hormone therapy generally increased a woman's probability of being referred correctly. For low risk group (defined as without dense breasts, family history, and not currently using hormone therapy), the average loss of specificity ranged from 3.6% to 5.7% and the gain of sensitivity was between 10.6% and 21.2% with the addition of CBE.
CONCLUSIONS
The addition of CBE to mammography would increase the overall sensitivity and decrease the specificity. CBE can be targeted to those women in which it has the highest net benefit.
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