Review article| Volume 92, P61-63, October 2016

The role of clinical breast examination in cancer screening for women at average risk: A mini review


      • Breast cancer screening is topical as debate about screening mammography continues.
      • Clinical breast examination alone leads to earlier diagnosis of breast cancer than no screening at all.
      • Earlier detection of cancer by clinical breast examination is not proven to reduce mortality.
      • For women who have mammography screening, clinical breast examination is of little benefit.
      • For women who do not have mammography screening, clinical breast examination may be of benefit.


      As the debate about the potential benefits and harms of screening mammography continues, it is timely to consider the role of clinical breast examination in screening for women at average risk of breast cancer. This article reviews the results from clinical trials and discusses the varied recommendations around the world. It concludes that the evidence does not support routine clinical breast examination for women participating in screening mammography programs, but there may be a benefit for women not do not have mammographic screening, especially in developing nations where health literacy and ‘breast awareness’ levels may be lower. This review provides information for clinicians to support women who are making decisions about the increasingly complex issue of breast cancer screening.


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      1. American Cancer Society, Breast Cancer Prevention and Early Detection, 2015).

      2. Cancer Australia, Early detection of breast cancer. <>, 2015, (accessed May 2016.).

        • Lauby-Secretan B.
        • Scoccianti C.
        • Loomis D.
        • Benbrahim-Tallaa L.
        • Bouvard V.
        • Bianchini F.
        • Straif K.
        Breast-cancer screening—viewpoint of the IARC working group.
        New Engl. J. Med. 2015; 372: 2353-2358
      3. National Comprehensive Cancer Network (NCCN), Breast Cancer Screening and Diagnosis. <>, 2015, (accessed May 2016.).

        • World Health Organization
        WHO Postition Paper on Mammography Screening.
        WHO Press, Geneva Switzerland2014
        • Shapiro S.
        • Venet W.
        • Strax P.
        • Venet L.
        Periodic Screening for Breast Cancer: The Health Insurance Plan Project and Its Sequelae, 1963–1986.
        The Johns Hopkins University Press, Baltimore, Md1988
        • Alexander F.E.
        • Anderson T.J.
        • Brown H.K.
        • Forrest A.P.
        • Hepburn W.
        • Kirkpatrick A.E.
        • McDonald C.
        • Muir B.B.
        • Prescott R.J.
        • Shepherd S.M.
        • et al.
        The Edinburgh randomised trial of breast cancer screening: results after 10 years of follow-up.
        Br. J. Cancer. 1994; 70: 542-548
        • Miller A.B.
        • Baines C.J.
        • To T.
        • Wall C.
        Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40–49 years.
        CMAJ. 1992; 147: 1459-1476
        • Miller A.B.
        • Baines C.J.
        • To T.
        • Wall C.
        Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50–59 years.
        CMAJ. 1992; 147: 1477-1488
        • Gotzsche P.C.
        • Jorgensen K.J.
        Screening for breast cancer with mammography.
        Cochrane Database Syst. Rev. 2013; 6: Cd001877
        • Barton M.B.
        • Harris R.
        • Fletcher S.W.
        Does this patient have breast cancer?: The screening clinical breast examination: should it be done? how?.
        JAMA. 1999; 282: 1270-1280
        • Campbell H.S.
        • Fletcher S.W.
        • Pilgrim C.A.
        • Morgan T.M.
        • Lin S.
        Improving physicians’ and nurses’ clinical breast examination: a randomised controlled trial.
        Am. J. Prev. Med. 1991; 7: 1-8
        • Corbelli J.
        • Bonnema R.
        • Rubio D.
        • Comer D.
        • McNeil M.
        An effective multimodal curriculum to teach internal medicine residents evidence-based breast health.
        J. Grad. Med. Educ. 2014; 6: 721-725
        • Roberts M.M.
        • Alexander F.E.
        • Anderson T.J.
        • Chetty U.
        • Donnan P.T.
        • Forrest P.
        • Hepburn W.
        • Huggins A.
        • Kirkpatrick A.E.
        • Lamb J.
        • et al.
        Edinburgh trial of screening for breast cancer: mortality at seven years.
        Lancet. 1990; 335: 241-246
        • Chamberlain J.
        • Coleman D.
        • Ellman R.
        • et al.
        Sensitivity and specificity of screening in the UK Trial of Early Detection of Breast Cancer.
        in: Miller A.B. Chamberlain J. Day N.E. Hakama M. Prorok P.C. Cancer Screening. Cambridge University Press, Cambridge1991: 3-17
        • Edeiken S.
        Mammography and palpable cancer of the breast.
        Cancer. 1988; 61: 263-265
        • Seidman H.
        • Gelb S.K.
        • Silverberg E.
        • LaVerda N.
        • Lubera J.A.
        Survival experience in the breast cancer detection demonstration project.
        CA Cancer J. Clin. 1987; 37: 258-290
        • UK Trial of Early Detection of Breast Cancer Group
        Specificity of screening in United Kingdom trial of early detection of breast cancer.
        BMJ. 1992; 304: 346-349
        • Sankaranarayanan R.
        • Ramadas K.
        • Thara S.
        • Muwonge R.
        • Prabhakar J.
        • Augustine P.
        • Venugopal M.
        • Anju G.
        • Mathew B.S.
        Clinical breast examination: preliminary results from a cluster randomized controlled trial in India.
        J. Natl. Cancer Inst. 2011; 103: 1476-1480
      4. Mammacare, Mammacare: The Standard for Clinical and Personal Breast Examination., 1995, (accessed May 2016.).

        • Mittra I.
        • Mishra G.A.
        • Singh S.
        • Aranke S.
        • Notani P.
        • Badwe R.
        • Miller A.B.
        • Daniel E.E.
        • Gupta S.
        • Uplap P.
        • Thakur M.H.
        • Ramani S.
        • Kerkar R.
        • Ganesh B.
        • Shastri S.S.
        A cluster randomised, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening.
        Int. J. Cancer. 2010; 126: 976-984
        • Andresen E.M.
        • Peterson-Besse J.J.
        • Krahn G.L.
        • Walsh E.S.
        • Horner-Johnson W.
        • Iezzoni L.I.
        Pap, mammography, and clinical breast examination screening among women with disabilities: a systematic review.
        Womens Health Issues. 2013; 23: e205-e214
        • Islam R.M.
        • Bell R.J.
        • Billah B.
        • Hossain M.B.
        • Davis S.R.
        Awareness of breast cancer and barriers to breast screening uptake in Bangladesh: a population based survey.
        Maturitas. 2016; 84: 68-74