OHSU Outreach Program Teaches Primary Care Clinicians How To Do Better Breast Exams

08/06/01    Portland, Ore.

New screening method increases lump detection and reduces false findings

Early detection of breast cancer among women increased dramatically in recent years thanks to greater awareness of mammography and breast self-examination. But a new program offered by Oregon Health & Science University teaches Oregon clinicians to conduct breast exams in a way that greatly increases lump detection and reduces false positive findings by 59 percent, leading to greater confidence in the clinician's breast exam skills.

"Clinicians in the training program have been extremely impressed with the rapid improvement of their breast exam skills," said Nancy Prouser, M.S., Clinical Breast Exam (CBE) training program manager at OHSU. The program teaches clinicians to check the entire perimeter of the breast instead of just the breast mound, and to use an optimal search pattern. "Think of the area to be examined as a rectangular lawn that needs to be mowed," said Prouser. "You do not just mow a circle in the middle of the lawn, instead you mow the entire lawn in up-and-down strips." It is important to check for lumps using three levels of pressure, and clinicians should use the pads of their fingers and one hand instead of two, she said. "The pads are the most sensitive part of our fingers, and the brain is not as effective if it receives input from more than one stimulus," said Prouser. "These small technique differences add up to big answers."

The CBE program, developed by a national group of breast cancer experts, has two parts and each count toward Continuing Medical Education credits. A self-study component must be completed before a skills session and includes information about risk management and appropriate follow-up for different types of findings. The skills session is conducted at the clinician's office by a CBE faculty instructor who introduces the clinician to exam techniques that maximize lump detection and differentiation using silicone breast models. The clinician then practices these new skills on a patient instructor who gives feedback and makes suggestions.

"Using a patient instructor is the best part of the program because the patient gives immediate feedback about the clinician's skills, such as, 'you missed an area,' or 'you can press harder,'" said Prouser. Patient instructors have been recruited from the local area and are trained to give appropriate feedback. "These women are committed to furthering women's health and have a vested interest in the fight against breast cancer. Some of these women have a family history of breast cancer or have a close friend who is battling the disease."

The CBE program was developed and piloted to train the primary care providers who screen women for the Oregon Breast and Cervical Cancer (BCC) program in the Oregon Health Division. Approximately 250 providers were trained in the state program. Response to the course was so overwhelming that it was moved to OHSU last November and allows all providers, not just BCC providers, to participate in the course. More than 70 clinicians have participated since the program was transferred to OHSU.

Tuition support is offered by Oregon BCC, Northwest Health Foundation, Spirit Mountain Community Fund and Northwest Physicians Mutual Insurance company. For more information or to register, call 503 494-8262, ext. 51146 or e-mail prousern@ohsu.edu.