Abstract
Objective:Manufactured silicone breast models were used to compare the accuracy of breast examination by 300 women and 62 internal medicine residents.
Design:The study design was cross-sectional.
Setting:The study took place in two teaching-hospital general medicine clinics.
Patients/Participants:Women were continuing care patients, ages 40 to 68, with no current breast complaint; 300 of 467 (66%) randomly selected women participated. Physicians were internal medicine residents with at least one-half day per week of ambulatory care practice; 62 of 64 (97%) participated.
Measurements and Main Results:Sensitivity equalled the percentage of 18 lumps correctly detected in examination of six silicone breast models. Specificity equalled the percentage of six models examined without a false-positive detection. Women’s sensitivity was lower than physicians’ (40% vs. 58%), but their specificity was higher (66% vs. 52%). For both women and physicians, sensitivity varied according to lump size, hardness, and depth, with women’s sensitivity lower than physicians’ for each characteristic. Examination duration was the technique most strongly and consistently related to accuracy. Physicians spent more time examining models than did women (2.5 vs. 2.1 minutes per model). For both groups duration related positively to sensitivity (r=0.46, women; 0.55, physicians) and negatively to specificity (r=−0.35, women; −0.59, physicians). After adjusting for differences in technique, women’s sensitivity remained lower than physicians’, whereas specificity generally remained higher. The sensitivity of physicians with prior tactile experience with breast lumps was higher than that of physicians without such experience (60% vs. 51%, p=0.01). Too few women (2%) had prior tactile experience to permit analysis.
Conclusions:Women’s and physicians’ breast examination accuracies differ, but for the two groups accuracies vary similary by lump characteristics and examination technique. Programs to improve breast examination should focus on specificity as well as sensitivity. Training that includes tactile experience may be important.
Similar content being viewed by others
References
Eddy DM. Guidelines for the cancer-related check-up. Recommendations and rationale. CA 1980;30:194–240.
Council on Scientific Affairs, American Medical Association. Early detection of breast cancer. JAMA 1984;252:3008–11.
Health and Public Policy Committee, American College of Physicians. The use of diagnostic tests for screening and evaluating breast cancer. Ann Intern Med 1985;103:143–6.
O’Malley MS, Fletcher SW. Screening for breast cancer with breast self-examination. A critical review. JAMA 1987;257:2196–203.
Miller AB, Chamberlain J, Tsechkovski M. Self-examination in the early detection of breast cancer. A review of the evidence with recommendations for further research. J Chronic Dis 1985;38:527–40.
Howard J. Breast self-examination. Issues for research. Bethesda, MD: Mational Cancer Institute, 1984.
Hall DC, Adams CK, Stein GH, et al. Improved detection of human breast lesions following experimental training. Cancer 1980;46:408–14.
Howe HL. Proficiency in performing breast self-examination. Patient Counsel Health Educ 1980;2:151–3.
Alagna SW, Reddy DM. Predictors of proficient technique and successful lesion detection in breast self-examination. Health Psychol 1984;3:113–27.
Assaf A, Cummings KM, Walsh D. The relationship between breast self-examination frequency, technique, and breast lump detection. In: Mettlin C, Murphy GP, eds Progress in cancer control: IV. Research in the cancer center. New York: Alan R. Liss, 1983;323–9.
Haughey BP, Marshall JR, Mettlin C, et al. Nurses’ ability to detect nodules in silicone breast models. Oncol Nurs Forum 1984;11:37–42.
Fletcher SW, O’Malley MS, Bunce LA. Physicians’ abilities to detect lumps in silicone breast models. JAMA 1985;253:2224–8.
Fletcher SW, Morgan TM, O’Malley MS, Earp JA, Degnan D. Is breast self-examination predicted by knowledge, attitudes, beliefs, or sociodemographic characteristics? Am J Prev Med 1989 (in press).
Baines CJ. Breast palpation technique. What is the finger pad? J Chronic Dis 1987;40:361–2.
Howe HL. Breast self-examination palpation skill. A methodological note. J Chronic Dis 1985;38:995–1001.
Saunders KJ, Pilgrim CA, Pennypacker HS. Increased proficiency of search in breast self-examination. Cancer 1986;58:2531–7.
Baker LH. Breast cancer detection demonstration project. Five year summary report. CA 1982;32:194–225.
Pennypacker HS, Bloom HS, Criswell EL, et al. Toward an effective technology of instruction in breast self-examination. Int J Ment Health 1982;11:98–116.
Shapiro S, Venet W, Strax P, et al. Ten-to-fourteen year effect of screening on breast cancer mortality. J Natl Cancer Inst 1982;69:349–55.
Author information
Authors and Affiliations
Additional information
Supported by a grant from the National Center for Health Services Research and Health Care Technology Assessment (R01HS05184) and by a grant from the Center for Disease Control and the University of North Carolina Center for Health Promotion and Disease Prevention.
Rights and permissions
About this article
Cite this article
Fletcher, S.W., O’Malley, M.S., Pilgrim, C.A. et al. How do women compare with internal medicine residents in breast lump detection?. J Gen Intern Med 4, 277–283 (1989). https://doi.org/10.1007/BF02597396
Issue Date:
DOI: https://doi.org/10.1007/BF02597396