1999 From: Harvard Medical School
Researchers advocate improved breast cancer screening techniquesReview of clinical data indicates need for standardized examination to improve physicians' precision and accuracy BOSTON, MA - September 30, 1999 - Standardized examination techniques are needed to improve physicians' accuracy in screening for breast cancer, according to a review article in the October 6, 1999 edition of the Journal of the American Medical Association. Despite the general acceptance and practice of screening for breast cancer, available data indicates that establishing uniform techniques would likely increase early detection of the disease, according to researchers at Harvard Pilgrim Health Care and Harvard Medical School. Breast cancer is the second leading cause of cancer deaths in women, and is the leading cause of cancer deaths among women aged 40 to 55. Experts agree that a combination of early detection and timely treatment can and does save women's lives. A standardized clinical breast examination (CBE) would likely increase early detection by improving examiners' sensitivity to lumps in the breast. Failure to diagnose breast cancer is a leading reason for malpractice claims, and clinicians who do not perform careful screening may be at increased risk of medical liability. The review's findings indicate that spending adequate time on the CBE and using the proper techniques improves breast lump detection, although the authors point out that summarizing the precision and accuracy of the CBE is difficult. Even when performed in large-scale studies, the examination technique generally has not been standardized. The available studies included women differing in age, history of symptoms, and practice settings. Furthermore, the reported test characteristics of the CBE in the available studies were determined sometimes with and sometimes without accompanying mammography screening. Studies utilizing silicone models of the breast uniformly demonstrate that examiners employing correct CBE techniques had higher lump detection rates than those who did not. For this review, Mary Barton, MD, MPP, and other researchers at the Department of Ambulatory Care and Prevention, a joint department of Harvard Pilgrim Health Care and Harvard Medical School, reviewed a total of 110 articles between the years 1966 and 1997 on the effectiveness and test characteristics of the CBE. They pooled data from several studies to demonstrate that five variables are important in properly palpating the breast. The variables are: 1) patient position, 2) breast boundaries, 3) examination search patterns, 4) finger position, movement, and pressure, and 5) duration of the exam. "Although the clinical breast examination is widely recommended and practiced, technique varies greatly. More studies are needed to determine whether the standard techniques can be taught and how effective they can be in improving the precision and accuracy of the clinical breast examination," said Barton. This study was funded by the Harvard Pilgrim Health Care Foundation. EDITORS: Barton is available to speak with reporters on Monday, October 4 throughout the day and on Tuesday, October 5 from 9:00 a.m. until 1:00 p.m. Please call Eric Linzer, HPHC, 617-731-7458, to reach Barton.
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