SALT LAKE CITYPhysical examination of the breasts by a woman and her health
care provider remains an important means of detecting breast cancer, especially
in young women, according to a study reported at the 45th Annual Meeting of the
American Society for Therapeutic Radiology and Oncology (abstract 194). The
study found that physical examination was the sole method of breast cancer
detection in nearly half of women younger than 40.
"The purpose of this study was to look at the characteristics and outcomes
of women in whom physical examination was the sole method of breast cancer
detection. In other words, we were looking at women whose cancers presented as
palpable breast masses and whose mammograms were negative," said lead author
Hasmik Diratzouian, MD, a resident in radiation oncology at Fox Chase Cancer
Dr. Diratzouian and her colleagues retrospectively studied 2,431 women who
had stage I or II breast cancer (including T1 and T2 tumors) and who were
treated with breast-conserving surgery, axillary node dissection, and adjuvant
radiation therapy, with or without systemic therapy, between 1970 and 1999. The
patients had a median age of 56 years (range, 22 to 93 years).
Outcomes were assessed over a median duration of 82 months and compared with
respect to clinical factors (age, tumor size, family history, and detection
method); pathologic factors (nodal status, an extensive intraductal component,
lymphovascular invasion, final margin status, and tumor grade); and
treatment-related factors (use of chemotherapy and use of tamoxifen).
Nearly half of the women (46%) had both an abnormal mammogram and an
abnormal physical exam (breast self-exam and/or clinical breast exam), and
about one third (35%) had an abnormal mammogram but a normal physical exam.
However, a substantial proportion (19%) had an abnormal physical exam but a
normal mammogram, she said.
Significantly larger proportions of cancers detected by physical exam alone
than of cancers detected by mammography alone occurred in women who were
younger than age 40 (25% vs 2%), had large (T2) tumors (30% vs 11%), had
axillary node involvement (30% vs 15%), and were treated with chemotherapy (39%
"Looking a little more closely at the young women, we found that in women
under 40 years of age, physical exam was the sole method of detection in 45% of
cases. In contrast, in those over age 50, 44% of those cancers were detected by
an abnormal mammogram and normal breast exam," Dr. Diratzouian noted.