Clinical Breast Exam 1 Running Head: CLINICAL BREAST EXAM The Accuracy of Clinical Breast Exam An Evidenced-Based Practice Project

ors coded examination results into one of four categories based on clinician’s recorded impressions and follow-up recommendations: (1) normal, (2) abnormal benign (fibrocystic changes not requiring further evaluation), (3) indeterminate (e.g., new abnormality requiring Clinical Breast Exam 15 diagnostic testing or follow-up), or (4) suspicious for cancer. CBE results were described as positive if coded indeterminate or suspicious and coded as negative if CBE results were normal or abnormal benign. The results indicated that over one-third (34.8%) of women who received screening CBE had either a family history of breast cancer or a personal history of breast biopsy and were classified as increased risk for breast cancer. Among women who received diagnostic CBE, twothirds (65.5%) were considered increased risk by these criteria. Among 930 average risk women who received 1,387 screening CBE’s, 9 (0.7%) were interpreted as indeterminate and none were interpreted as suspicious for cancer. Among 497 increased risk women who received 819 screening CBE’s, 23 (2.8%) were indeterminate and 1 (1.0%) was suspicious for cancer. The specificities among average and increased risk women, respectively, were 99.4% and 97.1%. Among 61 average risk women who received 115 diagnostic CBE’s, 36 (31.3%) were indeterminate and none were suspicious for cancer. Among 116 increased risk women who received 266 diagnostic CBE’s, 100 (37.6%) were indeterminate and 15 (5.3%) were suspicious for cancer. The specificities of diagnostic CBE were 68.7% among average risk women and 57.1% among increased risk women. This retrospective review is a 3a in the level of hierarchy of evidence (Straus et al., 2005). The findings of this study suggest that CBE in community practice has substantially higher specificity than in clinical trials of breast cancer screening. Diagnostic CBE is rather non specific. It is important for clinicians to perform high-quality CBE, noting that this will require more time and skill. The specificity of CBE was much lower for women at increased risk for breast cancer. This could have been due to perceived risk increase by providers in these women. Clinical Breast Exam 16 Conclusion The research available concerning the accuracy of CBE principally consists of retrospective studies and reviews of large databases. These evaluations jointly represent the importance of CBE in the realm of caring for women and their special and specific needs. Because large databases are available, these retrospective evaluations are able to assess significant numbers of women over long periods of time and form conclusions based on large sample sizes. The single prospective study discussed in the literature review dealt with the ability of an experienced physician in predicting the presence or absence of breast cancer prior to an open biopsy procedure. This study produced beneficial data, but the surgeon considered other aspects such as the patient’s medical history and mammogram results along with CBE prior to making the prediction. The proposed evidence-based inquiry will make predictions preceding the consideration of mammographic findings in hopes that the efficacy of the CBE will be better understood. Although accurately performed CBE alone has not been proven to decrease the breast cancer rate, it is highly likely that it can detect a fair amount of early breast cancers that might not be recognized otherwise (Kopans, 2007). Kopans (2007) states, “Only those who are interested in its performance and are willing to be trained and spend the time should be relied on to perform CBE’s” (p. 742). This profound statement is a challenge to advanced practice nurses and other health care professionals performing CBE to improve upon physical examination skills and consider this an evaluation deserving of great time, effort, and attention. Much of the literature pointed out that CBE has not been evaluated separate from mammography. The proposed analysis will attempt to look at CBE as a single entity prior to correlating the findings from this exam with mammography and other techniques necessary for Clinical Breast Exam 17 precise diagnosis and treatment. Standard of care will therefore not be compromised. Other studies that could be forthcoming from this evaluation and supported by the previous literature cited are prospectively evaluating the sensitivity and specificity of CBE, developing CBE training programs, and eventual assessment of CBE cost effectiveness in conjunction with other technologies. The implications for nurse practitioners practicing in the discipline of radiology as well as in women’s health, primary care and other specialties rests on raising the standards of skill and knowledge in the field of breast health with the focus on the basic CBE. This awareness has the potential to positively touch the lives of women in an area that is known but feared by many, a topic alive and vibrant among populations all over the world. The literature suggests that CBE is a crucial part of the breast assessment and provides a necessary supplement to mammography. Prospective studies are needed to document the potential contributions of CBE when performed by providers with sufficient knowledge and skill. Clinical Breast Exam 18 ReferencesAmerican Cancer Society. (2007). Breast cancer facts and figures 2007-2008. RetrievedJuly 26, 2008, from http://www.cancer.org/downloads/STT/BCFF-Final.pdfAmerican Cancer Society. (2008). Can breast cancer be found early? Retrieved July 25, 2008,from http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_breast_cancer_be_found_early_5.aspBarton, M. B., Elmore, J. G., & Fletcher, S. W. (1999). Breast symptoms among women enrolledin a health maintenance organization: Frequency, evaluation, and outcome. 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