2015 Volume 24 Issue 1 Pages 132-138
Clinical breast examination（CBE）including inspection and palpation, mammography（MMG） and ultrasonography（US）have mainly been used for breast cancer screening, and each have different rates of cancer detection or undetectability according to their specific characteristics. We tried to search for a combination of examination methods that would facilitate effective breast cancer detection at screening, and the possibility of excluding CBE for routine screening was discussed. During a period of 2 years and 10 months, from January 2009 through October 2012, a total of 16,112women underwent screening at our institutions and 44 were found to have breast cancers. Their records at the time of initial screening, detailed examination and surgical operation were reviewed. The cancer detection rates were 40.9％ for CBE only, 90.9％ for mammography only, 97.7％ for US only, 100％ for CBE and MMG, 97.7％ for CBE and US, and 100％ for MMG and US. With regard to the stage of cancers at the time of detection, 0％ detected by CBE only were Stage0, which was a lower rate of detection than that for Stage I cancers by CBE only compared with those detected by other single examination methods, and the detection rate for Stage II cancers by any of the three methods was the same. The cancers not detected by CBE were those with calcification（which were detected by MMG）and small cancers less than 2cm in diameter（which were detected by US）. Cancers not detected by MMG were those in young individuals, those located in a dense breast mass, and small cancers less than 1.5cm in diameter（which were detected by US）. Cancers undetectable by US were those with calcification（which were detected by MMG） . From the above results, a combination of MMG and US appears to yield the best cancer detection rate. Stage analysis of detected cancers revealed that CBE was the least effective examination method. A combination of MMG and US proved to be effective for mutually detecting specific types of cancers that are difficult to visualize by any one of the two methods alone. CBE may be omitted from mass screening provided that screenees having symptoms are excluded by initially treating them as patients.
