Tumor size and detection in breast cancer: Self-examination and clinical breast examination are at their limit

Background: This study investigates to what extent tumor detection methods in breast cancer have changed and how this has influenced tumor size at initial diagnosis. Methods: 1054 breast carcinomas <= 5 cm, newly diagnosed between 1990 and 2006, were evaluated for the tumor detection methods used, namely self-detection (SD, n = 568), clinical breast examination (CBE, n = 212), and radiological breast examination (RBE, n = 237), and their corresponding tumor sizes. Results: During the study period, the proportion of cases found by RBE increased (p < 0.001), while median tumor size decreased (1990-1992: 22 mm; 2005/2006: 17 mm. Spearman rho = -0.12, p < 0.001). Nevertheless, SD remained the most frequent method of tumor identification (2005/2006: 48.9%). Carcinomas found by RBE were smaller (median size: 12 mm) than those found by the other two detection forms (SD: 21 mm, CBE: 21 mm; p < 0.001). Within the different methods, only in RBE was an appreciable decrease in the size of the detected tumors observed during the study period (Spearman rho = -0.14, p < 0.001; SD: Spearman rho = -0.05, p = 0.19; CBE: Spearman rho = -0.05, p = 0.43). Conclusion: Despite educational campaigns and high media coverage, the possibilities for improving the "classical" methods of tumor detection in breast cancer, self-detection and clinical breast examination, seem to be at their limit. The significant decrease in tumor size at time of detection observed in the last years is primarily only due to the increased use of breast imaging. Improved detection of smaller tumors may presumably be reached only by an increased use of radiological procedures. (C) 2008 Elsevier Ltd. All rights reserved.