{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:53:41Z","timestamp":1792022021021,"version":"4.4.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T00:00:00Z","timestamp":1634601600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T00:00:00Z","timestamp":1634601600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Parasol Foundation"},{"name":"Edmond J. Safra Center for Bioinformatics at Tel Aviv University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Women's Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Despite the controversy surrounding the role of clinical breast exam (CBE) in modern breast cancer screening, it is widely practiced. We examined the contribution of CBE in women undergoing routine screening mammography and in women under the screening age.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A retrospective cohort study including all women participating in a voluntary health screening program between 2007 and 2016. All participants undergo CBE; Screening mammography is done selectively based on age, breast imaging history and insurance coverage. Data collected included demographics, risk factors, previous imaging, and findings on CBE and mammography. Cancer detection rates within 3\u00a0months of the visit were calculated separately for women undergoing routine screening mammography, and women under the screening age.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There were 14,857 CBE completed in 8378; women; 7% were abnormal. Within 3\u00a0months of the visit, 35 breast cancers (2.4 per 1000 visits) were diagnosed. In women within the screening age who completed a mammogram less than one year prior to the visit (N\u2009=\u20091898), 4 cancers (2.1 cancers per 1000 visits) were diagnosed. Only one was diagnosed in a woman with an abnormal CBE, suggesting that the cancer detection rate of CBE in women undergoing regular screening is very low (0.5 per 1000 visits). In women under the screening age (45), 3 cancers (0.4 per 1000 visits) were diagnosed; all were visualized on mammography, one had an abnormal CBE.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The contribution of CBE to cancer detection in women undergoing routine screening and in women under the screening age is rare.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12905-021-01507-x","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T09:18:16Z","timestamp":1634635096000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Contribution of clinical breast exam to cancer detection in women participating in a modern screening program"],"prefix":"10.1186","volume":"21","author":[{"given":"Tehillah S.","family":"Menes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Coster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Coster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shani","family":"Shenhar-Tsarfaty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,19]]},"reference":[{"key":"1507_CR1","doi-asserted-by":"publisher","unstructured":"Qaseem A, Lin JS, Mustafa RA, Horwitch CA, Wilt TJ. Screening for breast cancer in average-risk women: a guidance statement from the American College of Physicians. Ann Intern Med. 170(8):547\u2013560. https:\/\/doi.org\/10.7326\/M18-2147","DOI":"10.7326\/M18-2147"},{"key":"1507_CR2","doi-asserted-by":"publisher","unstructured":"Oeffinger KC, Fontham ETH, Etzioni R, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 314(15):1599-1614. https:\/\/doi.org\/10.1001\/jama.2015.12783","DOI":"10.1001\/jama.2015.12783"},{"key":"1507_CR3","unstructured":"NCCN Guidelines Version 1.2019 Breast Cancer Screening and Diagnosis. https:\/\/www.nccn.org\/professionals\/physician_gls\/p.  Accessed 1 Jan 2021."},{"key":"1507_CR4","doi-asserted-by":"publisher","unstructured":"Anderson BO, Bevers TB, Carlson RW. Clinical breast examination and breast cancer screening guideline. JAMA. 315(13):1403\u20131404. https:\/\/doi.org\/10.1001\/jama.2016.0686","DOI":"10.1001\/jama.2016.0686"},{"key":"1507_CR5","doi-asserted-by":"publisher","unstructured":"Ralph J. Coates, Robert J. Uhler, Donna J. Brogan, et al. Patterns and predictors of the breast cancer detection methods in women under 45 years of age (United States). Cancer causes Control. 12(5):431\u2013442. https:\/\/doi.org\/10.1023\/A:1011218005063","DOI":"10.1023\/A:1011218005063"},{"key":"1507_CR6","unstructured":"Breast cancer, invasive tumors. Accessed January 1, 2021. https:\/\/www.health.gov.il\/UnitsOffice\/HD\/ICDC\/ICR\/CancerIncidence\/Pages\/Breast_Invasive.aspx"},{"key":"1507_CR7","doi-asserted-by":"publisher","unstructured":"Hayek S, Enav T, Shohat T, Keinan-Boker L. Factors associated with breast cancer screening in a country with National Health Insurance: did we succeed in reducing healthcare disparities? J Women\u2019s Health (Larchmont, NY 2002). 26(2):159\u2013168. https:\/\/doi.org\/10.1089\/jwh.2016.5835","DOI":"10.1089\/jwh.2016.5835"},{"key":"1507_CR8","unstructured":"Israel National Cancer Registry. Accessed January 1, 2021. https:\/\/www.health.gov.il\/English\/MinistryUnits\/HealthDivision\/Icdc\/Icr\/Pages\/default.aspx"},{"key":"1507_CR9","doi-asserted-by":"publisher","unstructured":"Pisani P, Parkin D., Ngelangel C, et al. Outcome of screening by clinical examination of the breast in a trial in the Philippines. Int J Cancer. 118(1):149\u2013154. https:\/\/doi.org\/10.1002\/ijc.21343","DOI":"10.1002\/ijc.21343"},{"key":"1507_CR10","doi-asserted-by":"publisher","unstructured":"Mittra I, Mishra GA, Singh S, et al. A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening. Int J Cancer. 126(4):976\u2013984. https:\/\/doi.org\/10.1002\/ijc.24840","DOI":"10.1002\/ijc.24840"},{"key":"1507_CR11","doi-asserted-by":"publisher","unstructured":"Sankaranarayanan R, Ramadas K, Thara S, et al. Clinical breast examination: preliminary results from a cluster randomized controlled trial in India. JNCI J Natl Cancer Inst. 103(19):1476\u20131480. https:\/\/doi.org\/10.1093\/jnci\/djr304","DOI":"10.1093\/jnci\/djr304"},{"key":"1507_CR12","doi-asserted-by":"crossref","unstructured":"Shapiro S, Strax P VL. Periodic breast cancer screening in reducing mortality from breast cancer. JAMA. 1971;15(215(11)):1777\u20131785.","DOI":"10.1001\/jama.215.11.1777"},{"issue":"3","key":"1507_CR13","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1038\/bjc.1994.342","volume":"70","author":"FE Alexander","year":"1994","unstructured":"Alexander FE, Anderson TJ, Smith A, et al. The Edinburgh randomised trial of breast cancer screening: results after 10 years of follow-up. Br J Cancer. 1994;70(3):542\u20138. https:\/\/doi.org\/10.1038\/bjc.1994.342.","journal-title":"Br J Cancer"},{"key":"1507_CR14","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1093\/jncimono\/1997.22.31","volume":"22","author":"F Alexander","year":"1997","unstructured":"Alexander F. Randomized trial of breast cancer screening. J Natl Cancer Inst Monogr. 1997;22:31\u20135.","journal-title":"J Natl Cancer Inst Monogr"},{"key":"1507_CR15","doi-asserted-by":"crossref","unstructured":"Barton MB, Harris R, Fletcher SW. The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA. 282(13):1270\u20131280.","DOI":"10.1001\/jama.282.13.1270"},{"issue":"3","key":"1507_CR16","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.ypmed.2011.05.001","volume":"53","author":"AB Miller","year":"2011","unstructured":"Miller AB, Baines CJ. The role of clinical breast examination and breast self-examination. Prev Med (Baltim). 2011;53(3):118\u201320. https:\/\/doi.org\/10.1016\/j.ypmed.2011.05.001.","journal-title":"Prev Med (Baltim)"},{"key":"1507_CR17","unstructured":"Powered E. IHBCS. Breast cancer screening. Volumen 15. In: IARC HAndbooks of CAnCeR PReventIon. vol 15. (2017)"},{"issue":"1","key":"1507_CR18","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1258\/096914103321610761","volume":"10","author":"C Bancej","year":"2003","unstructured":"Bancej C, Decker K, Chiarelli A, Harrison M, Turner D, Brisson J. Contribution of clinical breast examination to mammography screening in the early detection of breast cancer. J Med Screen. 2003;10(1):16\u201321.","journal-title":"J Med Screen"},{"key":"1507_CR19","doi-asserted-by":"publisher","unstructured":"Chiarelli AM, Majpruz V, Brown P, Th\u00e9riault M, Shumak R, Mai V. The contribution of clinical breast examination to the accuracy of breast screening. JNCI J Natl Cancer Inst. 101(18):1236\u20131243. https:\/\/doi.org\/10.1093\/jnci\/djp241","DOI":"10.1093\/jnci\/djp241"},{"key":"1507_CR20","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1093\/jncimonographs\/lgi040","volume":"35","author":"JJ Fenton","year":"2005","unstructured":"Fenton JJ, Barton MB, Geiger AM, et al. Screening clinical breast examination: how often does it miss lethal breast cancer? J Natl Cancer Inst Monogr. 2005;35:67\u201371. https:\/\/doi.org\/10.1093\/jncimonographs\/lgi040.","journal-title":"J Natl Cancer Inst Monogr"},{"key":"1507_CR21","doi-asserted-by":"publisher","unstructured":"Jiang H, Walter SD, Brown P, Raina P, Chiarelli AM. Estimation of the benefit and harms of including clinical breast examination in an organized breast screening program. Breast (Edinburgh). 43:105\u2013112. https:\/\/doi.org\/10.1016\/j.breast.2018.11.012","DOI":"10.1016\/j.breast.2018.11.012"},{"key":"1507_CR22","doi-asserted-by":"publisher","unstructured":"Oestreicher N, Lehman CD, Seger DJ, Buist DSM, White E. The incremental contribution of clinical breast examination to invasive cancer detection in a mammography screening program. Am J Roentgenol. 184(2):428\u2013432. https:\/\/doi.org\/10.2214\/ajr.184.2.01840428","DOI":"10.2214\/ajr.184.2.01840428"}],"container-title":["BMC Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-021-01507-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12905-021-01507-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-021-01507-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T09:19:40Z","timestamp":1634635180000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcwomenshealth.biomedcentral.com\/articles\/10.1186\/s12905-021-01507-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,19]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1507"],"URL":"https:\/\/doi.org\/10.1186\/s12905-021-01507-x","relation":{},"ISSN":["1472-6874"],"issn-type":[{"value":"1472-6874","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,19]]},"assertion":[{"value":"6 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Institutional Review Board at Tel Aviv Sourasky Medical Center and informed consent was waived. All methods were carried out in accordance with relevant guidelines and regulations under Ethics approval and consent to participate.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have no conflict of interest to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"368"}}