Relation between clinical and mammographic diagnosis of breast problems and the cancer/biopsy rate

OBJECTIVE: To determine the sensitivity of mammographic and clinical assessment of breast problems, independent of one another, on the ratio of cancers found to biopsies performed (cancer/biopsy rate). DESIGN: A review of diagnoses from prospectively recorded and independently assessed clinical and mammographic examinations. SETTING: The breast clinic in a university-affiliated hospital. PATIENTS: Patients were considered in two age groups - under 50 years and 50 years and over; 1251 patients underwent breast biopsy between September 1976 and November 1994 after clinical assessment and mammography. MAIN OUTCOME MEASURE: The cancer diagnosis rate found on biol?sl, as a result of clinical and mammographic findings. RESULTS: In both age groups, mammography was significantly (P < 0.001) more sensitive than clinical assessment in cancer diagnosis but gave a significantly (p < 0.0001) higher rate of false-positive results. The cancer diagnosis rate was highest when lesions were assessed both clinically and mammographically as malignant but was of diagnostic benefit only to women in the under-50-year age group. The cancer rate was 12% when both assessments indicated a benign process and only 2% in women under age 50 years with clinically benign conditions who did not have mammography. Twenty-one percent of the biopsies were obtained in women with clinically normal breasts because of a mammographic abnormality and 17% of all the cancers found mere clinically occult. CONCLUSIONS: The sensitivity of clinical assessment, particularly in premenopausal women is lon and the false-positive mammography rate is high, but the cancer/biopsy rate is sufficiently high to warrant breast biopsy if either diagnostic modality suggests a cancer. When neither modality suggests cancer, the cancer/biopsy rate is 12% in both age groups.