Breast cancer screening by inspection and palpation has been taken place of mammographic screening in Japan. Is physical examination unnecessary for mammographic screening? We evaluated the role of physical examination. 17% of breast cancer cases are missed with the use of mammography alone in comparison of 80 breast cancers detected using mammography, ultrasound and physical examination. As a result, Adding physical examination to mammography, detection rates improved by 8%. Physical examination is a necessary part of mammographic screening.