对于乳腺癌风险较高的女性，国家综合癌症网络 (NCCN) 指南建议每 6-12 个月进行一次临床检查。虽然筛查性乳房X光检查可将乳腺癌死亡率的相对风险降低约20%，但验证临床乳房检查（CBE）作为有效筛查方式的证据仍然不足。我们的研究旨在评估定期 CBE 在乳腺癌发展风险较高的个体中检测乳腺癌的传统优点。对 2018 年 1 月 1 日至 12 月 31 日期间在 Corewell Health West 有记录的高风险遭遇的 18 岁以上女性进行了回顾性审查。高风险标准包括遗传易感性、5年（> 1.7%）或终生（> 20%）Tyrer-Cuzick和/或Gail模型风险评估、30岁之前胸部放疗、小叶原位癌或不典型增生。 2018年之前有乳腺癌病史或双侧预防性乳房切除术的患者被排除在外。在2493名女性的9171次累积高风险遭遇中，CBE仅检测到1例乳腺癌。 CBE 导致 1 例 (0.04%) 癌症诊断，而筛查成像检测到 30 例 (1.2%) 癌症，以及 10 例 (0.4%) 自我报告癌症。在 30 种图像检测到的癌症中，28 种（93.3%）在术前会诊时没有可检测到的临床发现。与影像学检测的恶性肿瘤相比，自我报告和 CBE 检测的癌症更有可能处于较高的临床分期。常规 CBE 作为癌症检测方式在高危患者群体中的作用似乎有限。可以为已完成筛查成像但无法进行现场高风险乳腺癌评估和/或因现场高风险乳腺癌评估而造成不便的个人提供远程医疗。© 2024。外科肿瘤学会。

For women at increased risk of breast cancer, the National Comprehensive Cancer Network (NCCN) guidelines recommend clinical encounters every 6-12 months. While screening mammography has corresponded with a relative risk reduction in breast cancer mortality of approximately 20%, evidence validating clinical breast examination (CBE) as an efficacious screening modality is deficient. Our study aimed to assess the conventional merit of regular CBE for breast cancer detection among individuals at increased risk of breast cancer development.Women > 18 years with documented high-risk encounters at Corewell Health West from 1 January 2018 to 31 December 22 were retrospectively reviewed. High-risk criteria included genetic predisposition, 5-year (> 1.7%) or lifetime (> 20%) Tyrer-Cuzick and/or Gail Model risk estimations, thoracic radiotherapy before age 30 years, lobular carcinoma in-situ, or atypical hyperplasia. Patients with a history of breast cancer or bilateral prophylactic mastectomy prior to 2018 were excluded.Of the 9171 cumulative high-risk encounters among 2493 women, only one breast cancer was detected by CBE. CBE resulted in 1 (0.04%) cancer diagnosis compared with 30 (1.2%) detected on screening imaging and 10 (0.4%) self-reported. Of the 30 image-detected cancers, 28 (93.3%) had no detectable clinical findings at the time of preoperative consultation. Self-reported and CBE-detected cancers were more likely to be of higher clinical stage compared with imaging-detected malignancies.The role of routine CBE as a cancer detection modality in the high-risk patient population appears to be limited. Telemedicine can be offered to individuals who have completed screening imaging but are unable to commit and/or are inconvenienced by in-person high-risk breast cancer assessments.© 2024. Society of Surgical Oncology.