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SAN ANTONIO, TX -- December 14, 2007 -- A large majority of women report that their doctors fail to perform adequate breast exams, according to an Internet-based survey reported here.
The results were presented in a poster here on December 13 at the 30th Annual San Antonio Breast Cancer Symposium (SABCS) by William H. Goodson III, MD, Senior Clinical Research Scientist, California Pacific Medical Research Institute, San Francisco, California.
"We conclude that clinicians are abandoning an essential clinical skill and with it the opportunity to improve diagnosis of the 15% of breast cancers that are invisible to mammograms," the poster said.
The finding came from a survey of women who visited an educational website (www.2minutebreastexam.com) in which a video shows a clinical breast exam lasting 2 minutes and 4 seconds, as suggested by Mahoney and Csima (CMA Journal 1982;127:729). The women were then asked to choose one of three options: your own annual exam is like the video, it is not like the video, or the doctor doesn't perform an exam.
Results are based on tabulation of a convenience sample of the first 320 survey respondents.
"We used the Internet because respondents needed proximate access to the video to make their comparisons and, logistically, it was most feasible to make the video accessible via the Internet," the researchers explained in their poster.
Twenty-one percent of respondents reported that the exams performed by their physicians were similar to the one portrayed in the video. About 4% said they receive no exam, and the remaining 75% said their exams are not like the video.
Dr. Goodson said the clinical implication -- based on previous research on the number of cancers missed by mammography but found by adequate clinical breast exam -- is that physicians fail to find some 30,000 to 32,000 breast cancers annually that could have been detected with a 2-minute exam.
According to previous research, about 12% of breast tumors are found by physicians in asymptomatic patients who do not have suspicious mammography findings, he added (Arch Int Med 2002;162:1343).
Other research has suggested that 5% of breast tumors go untreated when physicians find suspicious lumps on breast exam, but rely on negative mammography findings to make an overall negative diagnosis.
Over time, Dr. Goodson said, the percentage of women who visit www.2minutebreastexam.com that report an absent or inadequate clinical exam has remained very nearly constant, near 78%.
He acknowledged that the methodology of the survey may be imperfect, but said it was the best practical approach to determining what happens in clinical practice.
In addition to reluctance by some physicians to take the 2 minutes to perform an adequate exam, Dr. Goodson suggested that physicians might be worried that patients would suspect a sexual motive if they conduct an exam lasting that long.
However, according to the poster, research has indicated that breast exams should last at least 2 minutes, with some authors advocating exams of 5 to 8 minutes per breast.
"One might debate the minimal acceptable time for [clinical breast exam]," the poster said, but "the acceptable minimum is unlikely to be less than 2 minutes."
Dr. Goodson noted that the video focuses exclusively on the breast examination, excluding nodal palpation and other hands-on exams that may be conducted in conjunction with a breast exam.
He said that breast exams arguably are more important for women 40 to 60 years old than listening to the heart and lungs.
"Based on the response to our survey, we believe that, in addition to informing choices for cancer treatment, the Internet should be used to inform women of what they should be able to expect in breast cancer screening, especially for their periodic clinical breast exam," the researchers conclude.
[Presentation title: The Missing Exam in Clinical Breast Exam. Abstract 1034]
**Clinical breast exams or self exams are particularly valuable in detecting types of breast cancers that usually do not show up on mammograms. These types of cancers do not tend to calcify (form round, hard balls) like most breast cancers so they don?t show up on mammogram. Breast exams are best performed soon after your menstrual period ends, because your breasts will not be as tender and swollen as during your period.
**Submitted to CRAAB! by Breast Cancer Options News** |
