Detecting breast cancer: evidence for the significance of the mostly used methods
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Breast cancer (BC) is 10 times as frequent in women as cervical cancer. Mammography has been used as the most accepted modality to screen for BC. Also, breast self-examination (SE) has been promoted. Ultrasound has been evaluated as a supplement to mammography and in women at special risk. Palpation or clinical breast examination is regarded as a useful part of triple test (mammography palpation biopsy) for diagnosis of BC. Magnetic resonance imaging (MRI) has been investigated in risk groups and before surgery. The literature is reviewed and the conclusions given. Mammography has a sensitivity of up to 50-90%, dependent on the women’s age, breast tissue, hormonal intake and the presence of prostheses. The benefit of mammography screening for BC concerning survival of BC has been questioned. Ultrasound has a higher sensitivity compared with mammography in younger women, in women with familial risk and in women with mammographically dense breasts. There is no evidence for the benefit of palpation or instruction in SE for the detection of BC. Palpation has never been evaluated in controlled trials. MRI has a much higher sensitivity for BC than mammography but at the expense of more biopsies from benign structures. The introduction of MRI will change the reference for sensitivity. MRI could be the future method for detection of BC if cost and number of false positive cases can be reduced.