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Make the Diagnosis: Breast Cancer

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Prior Probability

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The risk of breast cancer increases as a function of age. The lifetime risk for US women is 12%. The annual risk is shown in Table 8-9.

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Table Graphic Jump Location
Table 8-9Breast Cancer Risk Increases With Age21
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Population for Whom a Screening CBE Should Be Considered

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  • Women who would be considered for mammography screening (eg, women 40 years and older) should be offered a CBE (Table 8-10).

  • Women with a positive family history for breast cancer may benefit from breast cancer screening starting at a younger age.

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Table Graphic Jump Location
Table 8-10Detecting the Likelihood of Breast Cancer
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Reference Standard Tests

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The reference standard for determining the outcomes of screening for breast cancer continues to be temporal follow-up, preferably 1 year after any negative testing result to ascertain true-negative status.

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Original Article: Does This Patient Have Breast Cancer? The Screening Clinical Breast Examination: Should It Be Done? How?

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Clinical Scenarios

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CASE 1
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On annual examination of a 64-year-old woman, you observe an 8-mm mass in her right breast. She says she never noticed the mass before. Her screening mammogram result 7 months ago was normal.

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CASE 2
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A 42-year-old woman comes to see you because she is upset. “I want a breast examination, doctor. My coworker was just diagnosed with breast cancer.” She practices breast self examination regularly. She has observed no changes in her breasts.

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Why Perform a Breast Examination?

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The clinical breast examination (CBE), like any part of the physical examination, can be used either for screening (to detect breast cancer in asymptomatic women) or diagnosis (to evaluate breast complaints, primarily to rule out cancer). In primary care, screening CBEs are more commonly performed than diagnostic CBEs. Of a total of 14 859 CBEs performed on a cohort of 2400 women during a 10-year period, 73% were for screening and 27% were diagnostic1 (Joann G. Elmore, MD, MPH, Harborview Medical Center, Seattle, Washington, written communication, November 1998). This review concentrates on the screening CBE because most research has been directed to screening rather than for diagnostic CBE. Because the ...

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