The Experts below are selected from a list of 29211 Experts worldwide ranked by ideXlab platform
Barbara A Pockaj - One of the best experts on this subject based on the ideXlab platform.
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clinical and self Breast Examination remain important in the era of modern screening
Annals of Surgical Oncology, 2012Co-Authors: Amylou C Dueck, Richard Gray, Nabil Wasif, Marina E Giurescu, Roxanne Lorans, Victor J Pizzitola, Barbara A PockajAbstract:Breast cancer screening recommendations are in flux. We reviewed the methods of detecting newly diagnosed Breast neoplasms at our institution. A retrospective review of patients stratified by age was performed to compare mammography with self- (SBE) and clinical (CBE) Breast Examination methods of cancer detection from 2005 to 2009. We identified 782 patients. Patients aged <50 years were more likely to present with palpable disease (P < 0.001). Overall, 75% of patients had a mammogram within 24 months. There was a higher incidence of Tis tumors and lower incidence of T1 tumors if patients had mammography performed within 12 months versus 13–24 months (P < 0.01); tumor size, hormonal status, and lymph node (LN) status were comparable between these two groups. Patients diagnosed by SBE/CBE who had mammography performed within 12 months versus 13–24 months did not differ statistically according to tumor characteristics. In the screened cohort (mammography within 24 months), the majority of patients (64%) were diagnosed by mammography. Cancers detected by SBE/CBE were larger tumors (2.4 vs. 1.3 cm), higher grade, more frequently ER- (29 vs. 16%), triple-negative (21 vs. 10%), and lymph node-positive (39 vs. 18%; all P ≤ 0.01). There were no statistically significant differences in tumor size, T stage, or hormonal status in patients who had analog versus digital mammography. Whereas the majority of patients had image-detected Breast cancer, a significant number of image-screened patients presented with palpable disease, which were more aggressive cancers. Until imaging techniques are refined, SBE and CBE remain important for Breast cancer diagnosis.
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clinical and self Breast Examination remain important in the era of modern screening
Annals of Surgical Oncology, 2012Co-Authors: Amylou C Dueck, Richard Gray, Nabil Wasif, Marina E Giurescu, Roxanne Lorans, Victor J Pizzitola, Barbara A PockajAbstract:Background Breast cancer screening recommendations are in flux. We reviewed the methods of detecting newly diagnosed Breast neoplasms at our institution.
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a significant number of women present with palpable Breast cancer even with a normal mammogram within 1 year
American Journal of Surgery, 2010Co-Authors: Danielle J Haakinson, Amylou C Dueck, Richard Gray, Nabil Wasif, Chee Chee H Stucky, Heidi A Apsey, Barbara A PockajAbstract:Abstract Background Although mammography is the gold standard for Breast cancer screening, clinical Breast Examination (CBE) and self Breast Examination (SBE) are important adjuncts whose utility has been questioned. Methods A retrospective review of invasive Breast cancer patients from 2000 to 2008 was performed. We compared 3 groups: Breast cancer detected by (1) imaging only (nonpalpable) or palpable mass with a normal mammogram (2) ≥1 year (mammogram ≥1 year) or (3) Results Of 1,222 women, presentation included 67% nonpalpable, 21% mammogram ≥1 year, and 13% mammogram Conclusion A significant number of women present with palpable Breast cancer within 1 year of a normal mammogram, many with an aggressive cancer. Therefore, we continue to advocate SBE and CBE for Breast cancer screening.
Suzanne W Fletcher - One of the best experts on this subject based on the ideXlab platform.
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Screening for Breast Cancer
JAMA, 2005Co-Authors: Joann G Elmore, Constance D. Lehman, Katrina Armstrong, Suzanne W FletcherAbstract:ContextBreast cancer screening in community practices may be different from that in randomized controlled trials. New screening modalities are becoming available.ObjectivesTo review Breast cancer screening, especially in the community and to examine evidence about new screening modalities.Data Sources and Study SelectionEnglish-language articles of randomized controlled trials assessing effectiveness of Breast cancer screening were reviewed, as well as meta-analyses, systematic reviews, studies of Breast cancer screening in the community, and guidelines. Also, studies of newer screening modalities were assessed.Data SynthesisAll major US medical organizations recommend screening mammography for women aged 40 years and older. Screening mammography reduces Breast cancer mortality by about 20% to 35% in women aged 50 to 69 years and slightly less in women aged 40 to 49 years at 14 years of follow-up. Approximately 95% of women with abnormalities on screening mammograms do not have Breast cancer with variability based on such factors as age of the woman and assessment category assigned by the radiologist. Studies comparing full-field digital mammography to screen film have not shown statistically significant differences in cancer detection while the impact on recall rates (percentage of screening mammograms considered to have positive results) was unclear. One study suggested that computer-aided detection increases cancer detection rates and recall rates while a second larger study did not find any significant differences. Screening clinical Breast Examination detects some cancers missed by mammography, but the sensitivity reported in the community is lower (28% to 36%) than in randomized trials (about 54%). Breast self-Examination has not been shown to be effective in reducing Breast cancer mortality, but it does increase the number of Breast biopsies performed because of false-positives. Magnetic resonance imaging and ultrasound are being studied for screening women at high risk for Breast cancer but are not recommended for screening the general population. Sensitivity of magnetic resonance imaging in high-risk women has been found to be much higher than that of mammography but specificity is generally lower. Effect of the magnetic resonance imaging on Breast cancer mortality is not known. A balanced discussion of possible benefits and harms of screening should be undertaken with each woman.ConclusionsIn the community, mammography remains the main screening tool while the effectiveness of clinical Breast Examination and self-Examination are less. New screening modalities are unlikely to replace mammography in the near future for screening the general population.
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does this patient have Breast cancer the screening clinical Breast Examination should it be done how
Obstetrical & Gynecological Survey, 2000Co-Authors: Mary B Barton, Russell Harris, Suzanne W FletcherAbstract:The authors conducted an extensive search of the literature and investigation of many published studies to collect information on the optimal use of clinical Breast Examinations (CBEs). All published clinical screening programs that used CBEs as part of the screening process were analyzed to determi
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does this patient have Breast cancer the screening clinical Breast Examination should it be done how
JAMA, 1999Co-Authors: Mary B Barton, Russell Harris, Suzanne W FletcherAbstract:ContextThe clinical Breast Examination (CBE) is widely recommended and practiced as a tool for Breast cancer screening; however, its effectiveness is dependent on its precision and accuracy.ObjectiveTo collect evidence on the effectiveness of CBE in screening for Breast cancer and information on the best technique to use.Data SourcesWe searched the English-language literature using the MEDLINE database (1966-1997) and manual review of all reference lists, as well as contacting investigators of several published studies for clarifications and unpublished data.Study Selection and Data ExtractionTo study CBE effectiveness, we included all controlled trials and case-control studies in which CBE was at least part of the screening modality; for technique, we included both clinical studies and those that used silicone Breast models. All 3 authors reviewed and agreed on the studies selected for inclusion in the pooled analyses.Data SynthesisRandomized clinical trials demonstrated reduced Breast cancer mortality rates among women screened by both CBE and mammography. Evidence of CBE's independent contribution was less direct; CBE alone detected between 3% and 45%of Breast cancers found that screening mammography missed. The precision of CBE was difficult to determine because of the lack of consistent and standardized Examination techniques. Studies on CBE precision reported fair agreement (κ=0.22-0.59). Pooling trial data, we estimated CBE sensitivity at 54% and specificity at 94%. The likelihood ratio of a positive CBE result is 10.6 (95% confidence interval [CI], 5.8-19.2), while the likelihood ratio of a negative test result is 0.47 (95% CI, 0.40-0.56). Longer duration of CBE and a higher number of specific techniques used were associated with greater accuracy. The preferred technique for CBE includes proper positioning of the patient, thoroughness of search, use of a vertical-strip search pattern, proper position and movement of the fingers, and a CBE duration of at least 3 minutes per Breast. The value of inspection is unproved. Professional and lay examiners improved their sensitivity on silicone Breast models after being taught this technique.ConclusionsIndirect evidence supports the effectiveness of CBE in screening for Breast cancer. Although the screening clinical Examination by itself does not rule out disease, the high specificity of certain abnormal findings greatly increases the probability of Breast cancer.
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ten year risk of false positive screening mammograms and clinical Breast Examinations
The New England Journal of Medicine, 1998Co-Authors: Joann G Elmore, Mary B Barton, Victoria M Moceri, Sarah Polk, Philip J Arena, Suzanne W FletcherAbstract:Background The cumulative risk of a false positive result of a Breast-cancer screening test is unknown. Methods We performed a 10-year retrospective cohort study of Breast-cancer screening and diagnostic evaluations among 2400 women who were 40 to 69 years old at study entry. Mammograms or clinical Breast Examinations that were interpreted as indeterminate, aroused a suspicion of cancer, or prompted recommendations for additional workup in women in whom Breast cancer was not diagnosed within the next year were considered to be false positive tests. Results A total of 9762 screening mammograms and 10,905 screening clinical Breast Examinations were performed, for a median of 4 mammograms and 5 clinical Breast Examinations per woman over the 10-year period. Of the women who were screened, 23.8 percent had at least one false positive mammogram, 13.4 percent had at least one false positive Breast Examination, and 31.7 percent had at least one false positive result for either test. The estimated cumulative risk...
Benjamin O Anderson - One of the best experts on this subject based on the ideXlab platform.
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association of previous clinical Breast Examination with reduced delays and earlier stage Breast cancer diagnosis among women in peru
JAMA Oncology, 2017Co-Authors: Anya Romanoff, Tara Hayes Constant, Kay M Johnson, Manuel Cedano Guadiamos, Ana Maria Burga Vega, Joseph R Zunt, Benjamin O AndersonAbstract:Importance Mammographic screening is impractical in most of the world where Breast cancers are first identified based on clinical signs and symptoms. Clinical Breast Examination may improve early diagnosis directly by finding Breast cancers at earlier stages or indirectly by heightening women’s awareness of Breast health concerns. Objective To investigate factors that influence time to presentation and stage at diagnosis among patients with Breast cancer to determine whether history of previous clinical Breast Examination is associated with earlier presentation and/or earlier cancer stage at diagnosis. Design, Setting, and Participants In this cross-sectional analysis of individual patient interviews using a validated Breast Cancer Delay Questionnaire, 113 (71.1%) of 159 women with Breast cancer treated at a federally funded tertiary care referral cancer center in Trujillo, Peru, from February 1 through May 31, 2015, were studied. Main Outcomes and Measures Method of Breast cancer detection and factors that influence time to and stage at diagnosis. Results Of 113 women with diagnosed cancer (mean [SD] age, 54 [10.8] years; age range, 32-82 years), 105 (92.9%) had self-detected disease. Of the 93 women for whom stage was documented, 45 (48.4%) were diagnosed with early-stage disease (American Joint Committee on Cancer [AJCC] stage 0, I, or II), and 48 (51.6%) were diagnosed with late-stage disease (AJCC stage III or IV). Mean (SD) total delay from symptom onset to initiation of treatment was 407 (665) days because of patient (mean [SD], 198 [449] days) and health care system (mean [SD], 241 [556] days) delay. Fifty-two women (46.0%) had a history of clinical Breast Examination, and 23 (20.4%) had undergone previous mammography. Women who underwent a previous clinical Breast Examination were more likely to have shorter delays from symptom development to presentation compared with women who had never undergone a previous clinical Breast Examination (odds ratio, 2.92; 95% CI, 1.30-6.60; P = .01). Women diagnosed with shorter patient delay were more likely to be diagnosed with early-stage disease (AJCC stage 0, I, or II) than those with longer patient delay (31 [58.5%] vs 11 [30.6%], P = .01). Women who underwent a previous clinical Breast Examination were more likely to be diagnosed with early-stage disease compared with women who had never undergone previous clinical Breast Examination; this relationship remained significant after controlling for insurance and household income (odds ratio, 2.44; 95% CI, 1.01-5.95; P = .048). Conclusions and Relevance In a population in which most Breast cancers are self-detected, previous clinical Breast Examination was associated with shorter patient delay and earlier stage at Breast cancer diagnosis. In regions of the world that lack mammographic screening, the routine use of clinical Breast Examination may provide a resource-appropriate strategy for improving Breast cancer early diagnosis.
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Breast cancer downstaging practices and Breast health messaging preferences among a community sample of urban and rural ugandan women
Journal of Global Oncology, 2017Co-Authors: John R Scheel, Constance D. Lehman, Benjamin O Anderson, Yamile Molina, Donald L Patrick, Gertrude Nakigudde, Beti ThompsonAbstract:PurposeAmong a community sample of Ugandan women, we provide information about Breast cancer downstaging practices (Breast self-Examination, clinical Breast Examination [CBE]) and Breast health messaging preferences across sociodemographic, health care access, and prior Breast cancer exposure factors.MethodsConvenience-based sampling was conducted to recruit Ugandan women age 25 years and older to assess Breast cancer downstaging practices as well as Breast health messaging preferences to present early for a CBE in the theoretical scenario of self-detection of a palpable lump (Breast health messaging preferences).ResultsThe 401 Ugandan women who participated in this survey were mostly poor with less than a primary school education. Of these women, 27% had engaged in Breast self-Examination, and 15% had undergone a CBE. Greater Breast cancer downstaging practices were associated with an urban location, higher education, having a health center as a regular source of care, and receiving Breast cancer educati...
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Breast health global initiative bhgi outline for program development in latin america
Salud Publica De Mexico, 2009Co-Authors: Benjamin O Anderson, Eduardo CazapAbstract:The Breast Health Global Initiative (BHGI) applied an evidence-based consensus review process to develop guidelines for Breast cancer early detection, diagnosis, and treatment in low- and middle-income countries (LMCs) including those in Latin America. Breast cancer outcomes correlate with the degree to which 1) cancers are detected early, 2) cancers can be diagnosed correctly, and 3) proper multimodality treatment can be provided in a timely fashion. Cancer prevention through health behavior modification may influence Breast cancer incidence in LMCs. Diagnosing Breast cancer at earlier stages will reduce Breast cancer mortality. Programs to promote Breast self-awareness and clinical Breast Examination and resource-adapted mammographic screening are important early detection steps. Screening mammography has been shown to reduce Breast cancer mortality, but is cost prohibitive in some settings. Breast imaging, initially with ultrasound and, at higher resource levels with diagnostic mammography, improves preoperative diagnostic assessment and permits image-guided needle sampling. Multimodality therapy includes surgery, radiation, and systemic therapies.
Amylou C Dueck - One of the best experts on this subject based on the ideXlab platform.
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clinical and self Breast Examination remain important in the era of modern screening
Annals of Surgical Oncology, 2012Co-Authors: Amylou C Dueck, Richard Gray, Nabil Wasif, Marina E Giurescu, Roxanne Lorans, Victor J Pizzitola, Barbara A PockajAbstract:Breast cancer screening recommendations are in flux. We reviewed the methods of detecting newly diagnosed Breast neoplasms at our institution. A retrospective review of patients stratified by age was performed to compare mammography with self- (SBE) and clinical (CBE) Breast Examination methods of cancer detection from 2005 to 2009. We identified 782 patients. Patients aged <50 years were more likely to present with palpable disease (P < 0.001). Overall, 75% of patients had a mammogram within 24 months. There was a higher incidence of Tis tumors and lower incidence of T1 tumors if patients had mammography performed within 12 months versus 13–24 months (P < 0.01); tumor size, hormonal status, and lymph node (LN) status were comparable between these two groups. Patients diagnosed by SBE/CBE who had mammography performed within 12 months versus 13–24 months did not differ statistically according to tumor characteristics. In the screened cohort (mammography within 24 months), the majority of patients (64%) were diagnosed by mammography. Cancers detected by SBE/CBE were larger tumors (2.4 vs. 1.3 cm), higher grade, more frequently ER- (29 vs. 16%), triple-negative (21 vs. 10%), and lymph node-positive (39 vs. 18%; all P ≤ 0.01). There were no statistically significant differences in tumor size, T stage, or hormonal status in patients who had analog versus digital mammography. Whereas the majority of patients had image-detected Breast cancer, a significant number of image-screened patients presented with palpable disease, which were more aggressive cancers. Until imaging techniques are refined, SBE and CBE remain important for Breast cancer diagnosis.
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clinical and self Breast Examination remain important in the era of modern screening
Annals of Surgical Oncology, 2012Co-Authors: Amylou C Dueck, Richard Gray, Nabil Wasif, Marina E Giurescu, Roxanne Lorans, Victor J Pizzitola, Barbara A PockajAbstract:Background Breast cancer screening recommendations are in flux. We reviewed the methods of detecting newly diagnosed Breast neoplasms at our institution.
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a significant number of women present with palpable Breast cancer even with a normal mammogram within 1 year
American Journal of Surgery, 2010Co-Authors: Danielle J Haakinson, Amylou C Dueck, Richard Gray, Nabil Wasif, Chee Chee H Stucky, Heidi A Apsey, Barbara A PockajAbstract:Abstract Background Although mammography is the gold standard for Breast cancer screening, clinical Breast Examination (CBE) and self Breast Examination (SBE) are important adjuncts whose utility has been questioned. Methods A retrospective review of invasive Breast cancer patients from 2000 to 2008 was performed. We compared 3 groups: Breast cancer detected by (1) imaging only (nonpalpable) or palpable mass with a normal mammogram (2) ≥1 year (mammogram ≥1 year) or (3) Results Of 1,222 women, presentation included 67% nonpalpable, 21% mammogram ≥1 year, and 13% mammogram Conclusion A significant number of women present with palpable Breast cancer within 1 year of a normal mammogram, many with an aggressive cancer. Therefore, we continue to advocate SBE and CBE for Breast cancer screening.
Cornelia J Baines - One of the best experts on this subject based on the ideXlab platform.
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the role of clinical Breast Examination and Breast self Examination
Preventive Medicine, 2011Co-Authors: Anthony B Miller, Cornelia J BainesAbstract:The efficacy of screening by clinical Breast Examination (CBE) and/or Breast self-Examination (BSE) is reviewed using indirect evidence from randomized Breast screening trials and that from observational studies. In countries where Breast cancer is diagnosed at an advanced stage, screening by CBE with the teaching of BSE as an integral component will probably be effective in reducing Breast cancer mortality. However, in technically advanced countries where adequate treatment is given, no screening modality is likely to be sufficiently beneficial to outweigh the harms of screening, especially false positives and over-diagnosis.
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clinical Breast Examination practical recommendations for optimizing performance and reporting
CA: A Cancer Journal for Clinicians, 2004Co-Authors: Debbie Saslow, Mary B Barton, Cornelia J Baines, Judy Hannan, Janet Osuch, Marianne H Alciati, Janet Kay Bobo, Cathy Coleman, Mary Dolan, Ginny GaumerAbstract:Clinical Breast Examination (CBE) seeks to detect Breast abnormalities or evaluate patient reports of symptoms to find palpable Breast cancers at an earlier stage of progression. Treatment options for earlier-stage cancers are generally more numerous, include less toxic alternatives, and are usually more effective than treatments for later-stage cancers. For average-risk women aged 40 and younger, earlier detection of palpable tumors identified by CBE can lead to earlier therapy. After age 40, when mammography is recommended, CBE is regarded as an adjunct to mammography. Recent debate, however, has questioned the contributions of CBE to the detection of Breast cancer in asymptomatic women and particularly to improved survival and reduced mortality rates. Clinicians remain widely divided about the level of evidence supporting CBE and their confidence in the Examination. Yet, CBE is practiced extensively in the United States and continues to be recommended by many leading health organizations. It is in this context that this report provides a brief review of evidence for CBE's role in the earlier detection of Breast cancer, highlights current practice issues, and presents recommendations that, when implemented, could contribute to greater standardization of the practice and reporting of CBE. These recommendations may also lead to improved evidence of the nature and extent of CBE's contribution to the earlier detection of Breast cancer.