Breast Exam Form Improves Referral Rate

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Breast exams by a doctor or other healthcare professional are an important part of breast cancer screening. About 10% of breast cancers are found by clinical exams and about 33% of these cancers aren't seen in a mammogram.

When clinicians find a suspicious area, they usually refer a woman for another evaluation and/or a mammogram or other screening test. This is called a referral for an advanced breast exam. A small study found that when professionals filled out a breast exam form, the number of referrals for advanced breast exams (the call rate) nearly doubled. This suggests that using a form to record breast exam results can improve the chances of finding suspicious areas during a clinical breast exam.

The researchers developed two breast exam forms (a simple form and a detailed form) for clinicians at a neighborhood medical center to use. The forms were filled out during the breast exam, but their purpose was to focus the clinician's attention on the breast exam while it was being done. Family doctors, general internists, nurse practitioners, and certified physician assistants all did breast exams in the study. The clinicians didn't have any special breast exam training during the study. The forms were used by the clinicians for 1 year.

The researchers compared the call rate during the year the forms were used to the call rate from the previous year. A higher call rate suggests that more suspicious findings were being noticed and referred for more evaluation, increasing the chances that breast cancer wouldn't be missed.

During the year the forms were used, the clinicians did 1,522 breast exams: 558 with the simple form and 964 with the detailed form. The clinicians referred 127 suspicious areas for evaluation, for a call rate of 8.3% when either form was used. In comparison, clinicians did 298 breast exams without using a form and 14 (4.7%) suspicious areas were referred for evaluation. So the call rate increased from 4.7% to 8.3% when a form was used.

It didn't seem to matter if the form was simple or detailed. Any type of form seemed to make the clinician doing the breast exam focus more intently on the exam.

It's important to know that even though the call rate increased, this study didn't find that using the forms improved the detection of early-stage breast cancer. This could be because the study was small. It's possible that if all clinicians who did breast exams used a form like the ones in this study, breast cancer detection would go up.

Using only one screening method for any disease is never perfect. This is why doctors recommend using several different screening tests. There are three screening methods for breast cancer. When all three are done consistently, chances go up that breast cancer will be diagnosed early, when it's most treatable.

The three breast cancer screening methods are:

  • Breast self-exams (BSE), which require only your time to learn how to do effectively and do regularly.
  • Clinical exams, done at least once per year, by a doctor or other medical professional responsible for your healthcare. Whether or not your clinician uses a form like ones described in this study, you may want to ask about the results right after the exam. Talking about the exam immediately after it may help focus the clinician on the exam like the forms seem to have done in this study.
  • A mammogram each year, starting at age 40.

If you have a higher-than-average risk of breast cancer, your screening plan may include more frequent tests and/or the use of other tests such as breast ultrasound and breast MRI.

Learn more breast cancer screening, including breast self-exams, in the Breastcancer.org Screening and Testing section.

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