Screening clinical breast examination.

Evidence suggests that CBE detects most breast cancers found by mammograms, and also some that mammograms miss, particularly in younger women. Recent estimates suggest that screening CBE has a sensitivity of about 54% and a specificity of about 94%. Yet, the impact of screening CBE on breast cancer mortality is still not clear, as there are no trials that have reported results comparing screening CBE alone to no screening. In some countries, the costs of screening mammography are considered too high, and policy makers are considering implementing screening programs based on CBE rather than mammography. In those countries with screening mammography programs already in place, screening CBE should also be included, as this will increase the overall sensitivity of breast cancer screening. Studies have shown that community health workers can be trained to conduct screening CBE, and that trained nurses perform CBE as well as physicians. Physicians should take on the responsibility to ensure that screening CBE is performed properly, however, and that it remains an integral part of all screening mammography programs.