Individual and combined effectiveness of palpation, thermography, and mammography in breast cancer screening

Detection data generated at a national Breast Cancer Detection Demonstration Project over a 4-year period are discussed. Interpretation of these data indicates that mammography with a true positive rate of 74% is the most sensitive individual detection modality for asymptomatic women. However, multimodality screening protocols can increase sensitivity to nearly 90%, with some decline in specificity. Two protocols are superior on the basis of sensitivity and specificity. One consists of independent interpretations of clinical and mammographic examinations without regard to medicohistorical data, with biopsy recommended if either is positive. In the other, biopsy is recommended only upon complete review of the medical record in the context of suspicious clinical, mammographic, or thermographic evaluations. Forty-four percent of all cancers detected on screening were 1 cm or less, and in 73% of the cancer cases there was no nodal involvement. These statistics especially reflect the value of mammography as an early detection modality. The rate of cancers detected per biopsy increased from 18 to 27% over the 4-year period indicating increased diagnostic expertise and highlighting the value of expert screening.