The Accuracy of Midwives' Clinical Breast Examination in Detection of Breast Lumps

Background: Screen-detected breast cancers are usually diagnosed at earlier stages. Therefore, countries withlimited resources are recommended to implement clinical breast examination (CBE) as a screening method inconjunction with mammography. Since there are so many limitations to performance of CBE by surgeons in thehealth system and CBE by midwives is more feasible, this study was conducted to test the agreement of CBE bymidwives and surgeons.
Methods: One thousand and twenty seven patients with no personal history of breast cancerreceived breast physical examination by both a midwife and a surgeon and designed forms including patients’ generalinformation, cause of referral and abnormal physical findings were completed for each patient.
Results: The interobserveragreement (kappa) for mass detection was 36 % (95% CI= 31% to 41%), indicating a “fair” agreementexists between the midwife’s and the surgeon’s physical examination. Sensitivity, specificity, positive and negativepredictive values of “midwife’s physical examination” to detect abnormal breast masses in comparison to “surgeon’sphysical examination” as the gold standard were 75, 67, 48, and 87 percent respectively.
Conclusions: The results ofthis study do not justify the replacement of general surgeons by midwives in the health care system as the firstexaminer for clinical breast screening. Decisions about this issue need more comprehensive studies considering costeffectivenessand training procedures.