Tuesday, January 6, 2009

SABC Article on Improving Clinical Breast Examinations

To all,

I wish everyone a happy and successful New Year.

Here is an article sent to me by Steve Weiss from the San Antonio Breast Conference concerning improving the Clinical Breast Examination. I believe that this article demonstrates that if the clinician were to use SureTouch, their effectiveness would improve dramatically.

I am following up with the author of the study.

Thanks Steve for forwarding this article.

Denis


December 15, 2008 (San Antonio, Texas) — Clinical attentiveness pays dividends when performing a breast examination, according to a new study presented here at the 31st Annual San Antonio Breast Cancer Symposium (SABCS).

In the study, when clinicians completed simple written forms during clinical breast examinations, the rate of breast mass detection nearly doubled vs examinations done without the forms.

Completing a form causes a clinician to focus attention during an examination that might otherwise be performed in a cursory manner, suggested lead study author William Goodson, MD, senior clinical research scientist at the California Pacific Medical Center Research Institute, in San Francisco. "If you ask doctors to stop and think, then they will do a better job," he said.

"You can make a clinical breast exam a high-quality tool simply by having people pay attention," observed Susan Love, MD, president of the Dr. Susan Love Research Foundation, who moderated the press conference at which these results were highlighted.

Use of the clinical breast examination has been in decline for some time and should be more valued by clinicians, said both Drs. Goodson and Love. In the late 1980s, approximately 95% of women had undergone both mammography and clinical breast examination. By the mid 1990s, only 50% to 75% of women had undergone both, noted Dr. Goodson.

Mammography detects about 85% of breast cancers, whereas clinical breast examinations detect about 60% of all breast cancers, said Dr. Goodson. Some breast cancers can only be found by clinical breast examination, he added. "Mammograms are not a very good tool in young women," said Dr. Love.

Using the clinical breast examination makes good sense, economically as well as diagnostically, Dr. Love added. "We keep inventing expensive tools like [magnetic resonance imaging, positron emission tomography], and 3D ultrasound, but we also need to use the breast exam, in part, because it is economical. For some women, it is the only exam they can afford to receive."

Restoring the clinical breast examination to its appropriate place among the screening tools available to clinicians is a passion of Dr. Goodson's, who is the founder of the 2 Minute Breast Exam Web site, which includes a demonstration video. "You only need 2 minutes to do a decent breast exam," he said.
Call Rate Doubles

In the 18-month prospective study, clinicians in a community-based primary-care practice recorded findings from breast examination screenings for 1522 routine visits. The clinicians were randomly assigned to use 1 of 2 forms: a short form that collected brief historic information about the patient and asked the clinician to mark any areas of abnormality on a graphic of the breasts; or a long form, which, in addition to the information on the short form, asked the clinician to record several descriptors of the patient's breasts in general.

For historic controls, the information that was collected with the short form was retrospectively abstracted from the charts of 300 women seen for routine care in the year preceding the study.

The study shows that the 2 different forms did not affect the "call rate" of the examinations, or the percentage of breast masses detected by the examinations. However, the call rate for the prospective study patients (8.3%) was significantly higher than the call rate in the preceding year (4.7%; P = .032), which suggests that the use of written forms during the examination increased clinician attentiveness, said Dr. Goodson.

Also, to assess the success in finding cancer with the breast examination, the study authors compared the number of cancers identified in the study sample vs the number expected on the basis of age-adjusted Surveillance, Epidemiology and End Results (SEER) data. The SEER data predicted 3.7 cancers in the 1822 women, and the examiners found 4.

The study's results encouraged the authors to question and dismiss a number of proposals currently being discussed in the medical community about the clinical breast examination. "We question enthusiasm for training in special techniques for clinical breast exam and legislative efforts to require separate CPT [current procedural terminology] codes for clinical breast exam. We conclude that focusing attention is as successful as special clinical breast exam choreography," Dr. Goodson said on behalf of the study authors.
Other Issues

A "decent" breast examination takes about 2 minutes, said Dr. Goodson. However, this is a bit of problem for some clinicians. "Both male and female physicians say that they feel awkward spending that much time touching their patients' breasts," he noted. The solution is partly in patient education. "We have to change patient expectations about the exam and make them realize it takes a bit of time," he said.

It is important for clinicians to take up the cause of the examination, he suggested, because the stakes are high. "The single leading cause of delay in breast cancer diagnosis is the result of a doctor feeling a mass but a follow-up mammography [not showing] a cancer; 5% of breast cancers are delayed in being diagnosed because of this scenario," he said. If the findings of clinical breast cancer examinations were more highly valued, then this form of delay would probably be less prominent because it would be more appreciated that the breast examination can detect some forms of breast cancer that mammography cannot, he suggested.

The researchers have disclosed no relevant financial relationships.

31st Annual San Antonio Breast Cancer Symposium (SABCS): Abstract 5012. Presented December 13, 2008.

12 comments:

  1. Happy New Year! Great article, thanks for sharing.

    ReplyDelete