Education And Debate

Is clinical breast examination an acceptable alternative to mammographic screening?

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7268.1071 (Published 28 October 2000) Cite this as: BMJ 2000;321:1071
  1. Indraneel Mittra, professor of surgerya,
  2. Michael Baum, professor emeritus of surgery (m.baum@ucl.ac.uk)b,
  3. Hazel Thornton, founder of Consumers Advisory Committee for Clinical Trialsc,
  4. Joan Houghton, director, CRC Unitd
  1. a Department of Surgical Oncology, Tata Memorial Hospital, Mumbai-400 012, India,
  2. b Department of Surgery, University College Medical School, London W1P 7LD,
  3. c Saionara, 31 Regent Street, Rowhedge, Colchester CO5 7EA,
  4. d CRC and UCL Cancer Trials Centre, Royal Free and University College London Medical School, London W1A 8AN
  1. Correspondence to: M Baum
  • Accepted 1 August 2000

Breast cancer screening and mammography have almost become synonymous in the public perception, yet this should not necessarily be the case. Ideally, a screening tool for breast cancer would reduce mortality from breast cancer while having a low false alarm rate and being relatively cheap. Screening should not be at the expense of the symptomatic services nor inappropriately divert scarce resources away from equally deserving areas of the NHS that are less politically sensitive.1

An ideal screening test would be simple, inexpensive, and effective. Of the three modalities of breast cancer screening—breast self examination, clinical breast examination, and mammography—breast self examination fulfils the first two criteria, but early results of two randomised trials conducted in Russia and China suggest that it would not be effective in reducing mortality from breast cancer. 2 3 Clinical breast examination is also relatively simple and inexpensive, but its effectiveness in reducing mortality from breast cancer has not been directly tested in a randomised trial. Mammography is complex, expensive, and only partially effective. We believe that there is sufficient circumstantial evidence to suggest that clinical breast examination is as effective as mammography in reducing mortality from breast cancer and that the time has come to compare these two screening methods directly in a randomised trial.

Summary points

The goal of breast screening is to prevent death and not simply to detect cancers by mammography

Mammography does detect some cancers “early,” but many of these are not potentially lethal and their detection causes needless anxiety

Clinical breast examination is more likely to detect cancers that are potentially lethal

Results of the second Canadian national breast screening study suggest that mammographic detection of cancers that are not palpable does not affect mortality

New GMC guidelines on informed consent state that women in the NHS breast screening programme should …

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