Clinical Breast Exam Update – Recent Findings

Clinical Breast Exams – Recent Findings  

Do Primary Care Physician Perform Clinical Breast Exams Prior to Ordering a Mammogram? Breast J. 2016 Mar-Apr;22(2):Despite recommendations, approximately 1/3 of women report not having CBE prior to mammogram. Lack of CBE can lead to incorrect type of mammogram, with possibly increased cost and delay in diagnosis.” (bold added)

Breast Cancer Subtype Influences the Accuracy of Predicting Pathologic Response by Imaging and Clinical Breast Exam After Neoadjuvant Chemotherapy. Anticancer Res. 2016 Oct;36(10):    “Clinical response evaluation by CBE was highly accurate for predicting pathologic residual disease in HR+ tumors (CBE PPV: 95.5% in HR+HER2-, 100.0% in HR+HER2+). In triple-negative breast cancer (TNBC), the imaging NPV was 100% and the imaging FNR was 0%.CONCLUSION:The use of imaging in HR+ tumors post-NACT may provide little to no additional value that is not already garnered by performance of a CBE. For TNBC, imaging may play a critical role in the prediction of pathologic complete response (pCR) post-NACT.” (bold added)

Palpable discrete breast masses in young women: Two of the components of the modified triple test may be adequate S. Afr. j. surg. vol.51 n.2 Cape Town Jan. 2013   “Palpable breast masses in young women, though usually benign, are a common source of anxiety.  “…This study shows that the concordant MTT for the diagnosis of palpable discrete breast masses in women below the age of 35 years is reproducible and yields high diagnostic accuracy. Of the elements of the MTT, FNAC was the most predictive. CONCLUSION: The combinations of CBE plus ultrasound and CBE plus FNAC have high PPVs and NPVs with almost similar concordance in this population, suggesting that they can be used for diagnosis and therefore could be modelled for use in patients choosing between conservative care and excision.“ (bold added)

Clinical Data as an Adjunct to Ultrasound Reduces the False-Negative Malignancy Rate in BI-RADS 3 Breast Lesions. Ultrasound Int Open. 2016 Sep;2(3) “Ultrasound (US) is a well-established diagnostic procedure for breast examination. We investigated the malignancy rate in solid breast lesions according to their BI-RADS classification with a particular focus on false-negative BI-RADS 3 lesions. .choice ensure adequate diagnostic Clinical criteria including age, family and personal history, clinical examination, mammography and patient procedures.” (bold added)

Improved Clinical Breast Examination Competencies via Intelligent Simulator Training e-Journals Zeitschrift für Mammadiagnostik und -therapie 2012; 9 – A49DOI: 10.1055/s-0032-1313415 “After a short training interval averaging 90 minutes (range: 62 to 145 minutes), the Florida participants’ mean true positive detections (sensitivity) doubled, (p<0.001). False positive detections reduced by half, (p=0.02) and exam thoroughness (area palpated), increased from 63% pretest to 96% posttest, (p<0.001). Mayo residents’ true positives increased from a mean of68% to 90%, (p<0.001). …” (bold added)

An Effective Multimodal Curriculum to Teach Internal Medicine Residents Evidence-Based Breast Health. J Grad Med Educ. 2014 Dec;6(4):721-5.. Breast health is an area fraught with controversy and missed opportunities to meet women’s needs, and the state of internal medicine residency training in this area is inadequate.   Our objective was to develop, implement, and evaluate a curriculum to equip internal medicine residents with the knowledge and skills to deliver high-quality, comprehensive breast health care.

We developed a 4-hour curriculum for internal medicine interns. It incorporated a team-based learning format and used MammaCare breast model software to teach and evaluate the clinical breast examination. We compared interns’ precurriculum and postcurriculum test results to a historical comparison group of postgraduate year (PGY)-2 interns who did not complete the curriculum. We retested interns as PGY-2s to assess knowledge retention.

A total 41 of 52 interns (79%) completed the curriculum. Their average MammaCare scores improved from 63% to 91%. Scores on a knowledge-based assessment improved from 47% on the pretest to 85% on the posttest (P < .001). Comparison PGY-2s who did not complete the curriculum averaged a score of 52% (P < .001). When retested 9 months after exposure to the curriculum, participants’ mean score was 63% (compared to historical comparison PGY-2 group, P < .001). Only 9% of interns who retook the test as PGY-2s reported having received any breast health training subsequent to curriculum completion.

A targeted half-day, low-cost breast health curriculum significantly improved knowledge and skills in multiple domains, and these improvements were retained in subsequent assessment despite minimal reinforcement in residency training. (bold added)

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Funded in part by the National Science Foundation

 

 Courtesy: The MammaCare Foundation 930 NW 8th Avenue, Gainesville, Florida 32601, contact: science@mammacare.org