RT Journal
A1 Goodson WH, III, Moore DH, II
T1 OVerall clinical breast examination as a factor in delayed diagnosis of breast cancer
JF Archives of Surgery
JO Archives of Surgery
YR 2002
FD October 1
VO 137
IS 10
SP 1152
OP 1156
DO 10.1001/archsurg.137.10.1152
UL http://dx.doi.org/10.1001/archsurg.137.10.1152
AB Hypothesis 
    A standardized description of clinical breast examination (CBE) can predict the risk of delayed diagnosis of breast cancer.Design 
    Survey of case series.Setting 
    Breast surgery referral practice.Patients 
    Consecutive sample of 371 women with 386 breast cancers of any stage for whom overall characteristics of CBE were recorded at the initial consultation.Intervention 
    None.Main Outcome Measures 
    Overall breast "durity" (from Latin duritia, meaning "hardness") was recorded as the inverse of whether rib edges could be felt through breast tissue in the most "dur" (firm or hard) part of the breast, usually the upper outer quadrant adjacent to the areola. "Nodularity" was recorded in this same area by means of an ordinal scale ranging from "surface is smooth" to "coarse nodularity." Delayed diagnosis was tabulated if the patient was told that cancer was not present when there was a sign of cancer on CBE, mammogram, and/or pathology slides. Relative risk of delayed diagnosis was determined within categories of nodularity or durity and within nodularity and durity categories combined.Results 
    Diagnosis was delayed for 35 (9.1%) of cancers. Delay was least common (2 [2.2%] of 92) for less dur and less nodular breasts (relative risk, 1.0), most common (18 [13.5%] of 133) for less dur and more nodular breasts (relative risk, 6.23; 95% confidence interval, 3.58-10.22), and intermediate for other descriptions (χ2 = 9.08; P = .03). Neither nodularity alone nor durity alone correlated with delay.Conclusions 
    A standardized system to describe CBE will alert physicians to an increased risk of delayed diagnosis of breast cancer (especially for women with less dur and more nodular breasts), help improve interpretation of CBE, and reduce delayed diagnosis of breast cancer.