When a woman or her provider feels a lump or sees an unusual change in the breast, the woman is typically referred for a mammogram. This is the common procedure but not the best one for the patient or the referring agency. When there is a physical sign, a lump or visible change in the breast, mammograms can delay diagnosis and treatment as well as miss breast cancer that is present.1
Physical Breast Exam with Targeted Ultrasound Best
Recent evidence from national health care programs finds that a physical exam is essential for early diagnoses.2 The latest evidence comes from Holland. Dr. Linda Appleman’s team investigated what happens when a self-detected symptom, lump (focal breast complaint) is immediately followed up by targeted ultrasound rather than a mammogram.3
From September 2017 to June 2019, 1,961 women in Holland reported feeling a lump and enrolled into Appleman’s study. Each woman received a targeted ultrasound (US) to determine if the lump she felt was a harmless water-filled cyst or a solid tumor that required biopsy. With ultrasound (US) as the primary imaging tool, 81% of women received normal (benign) results, and 10% of women received confirmation of a malignant tumor (US sensitivity, 98.5% [95% CI: 96, 100]; US specificity, 90.8% [95% CI: 89, 92]). DBT was used after an ultrasound reported negative lump finds to validate ultrasound’s accuracy in order to determine if US could be used as a stand-alone breast imaging modality for assessing lump finds from a physical breast exam.
Dr. Appleman concluded that “[ultrasound] was accurate as a stand-alone breast imaging modality in the assessment of focal breast complaints.”