Yes, I know that studies showed that clinical breast exams don’t add value to mammograms; but I don’t believe that they showed that breast exams don’t add value to nothing. Or did they?
The only study that specifically compared mammograms to clinical breast exam was CNBSS (1 and 2) and we all know what it showed (or not). There was a lot of criticism of CNBSS, most of which was shown to be unfounded: a) bad radiologist/equivipment – but their detection rate was better than in other trials b) too many women with cancer allocated to trial arm – but their early exess of breast cancers mirrors that of other trials.
At any rate 7-23% desease-specific relative reduction of mortality is not huge in absolute numbers; and if you take 30% overdiagnosis – a number mentioned in this report, an all-cause mortality from unnecessary treatment can easily exceed it.
Just a humble opinion.