Clinical breast examination (CBE) seeks to detect breast abnormalities or evaluate patient reports of symptoms to find palpable breast cancers at an earlier stage of progression.Treatment options for earlier-stage cancers are generally more numerous, include less toxic alternatives, and are usually more effective than treatments for later-stage cancers. For average-risk women aged 40 and younger, earlier detection of palpable tumors identified by CBE can lead to earlier therapy. After age 40, when mammography is recommended, CBE is regarded as an adjunct to mammography. Recent debate, however, has questioned the contributions of CBE to the detection of breast cancer in asymptomatic women and particularly to improved survival and reduced mortality rates. Clinicians remain widely divided about the level of evidence supporting CBE and their confidence in the examination. Yet, CBE is practiced extensively in the United States and continues to be recommended by many leading health organizations. It is in this context that this report provides a brief review of evidence for CBE's role in the earlier detection of breast cancer, highlights current practice issues, and presents recommendations that, when implemented, could contribute to greater standardization of the practice and reporting of CBE. These recommendations may also lead to improved evidence of the nature and extent of CBE's contribution to the earlier detection of breast cancer. (CA Cancer

No abstract

Purpose Recent national trends show decelerating declines in heart disease mortality, especially among younger adults. National trends may mask variation by geography and age. We examined recent county-level trends in heart disease mortality by age group. Methods Using a Bayesian statistical model and National Vital Statistics Systems data, we estimated overall rates and percent change in heart disease mortality from 2010 through 2015 for four age groups (35–44, 45–54, 55–64, and 65–74 years) in 3098 US counties. Results Nationally, heart disease mortality declined in every age group except ages 55–64 years. County-level trends by age group showed geographically widespread increases, with 52.3%, 58.5%, 69.1%, and 42.0% of counties experiencing increases with median percent changes of 0.6%, 2.2%, 4.6%, and −1.5% for ages 35–44, 45–54, 55–64, and 65–74 years, respectively. Increases were more likely in counties with initially high heart disease mortality and outside large metropolitan areas. Conclusions Recent national trends have masked local increases in heart disease mortality. These increases, especially among adults younger than age 65 years, represent challenges to communities across the country. Reversing these trends may require intensification of primary and secondary prevention—focusing policies, strategies, and interventions on younger populations, especially those living in less urban counties.

Million Hearts is a national initiative co-led by CDC and the Centers for Medicare & Medicaid Services that aims to prevent 1 million heart attacks, strokes, and other related acute cardiovascular events by 2022 (1,2). On November 19, 2019, the initiative recognized 17 Million Hearts Hypertension Control Champions for achieving ≥80% blood pressure control rates among their patients with hypertension. These Champions include clinicians, practices, health centers, and health systems from 15 states that provide care for 201,045 adult patients, approximately one third (68,019) of whom have hyperten

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), administered by the Centers for Disease Control and Prevention (CDC), provides breast and cervical cancer screening to low-income women who are uninsured or underinsured. For women with three consecutive annual Pap tests with normal findings, the NBCCEDP supports extending the screening interval to every 3 years. Thirteen telephone focus groups were conducted with physician providers in 17 states and the District of Columbia to investigate familiarity with NBCCEDP's triennial Pap test policy, the Pap test intervals actually used, and the factors influencing screening interval selection. No participants were familiar with NBCCEDP's triennial Pap test policy, and none reported routinely extending the screening interval after three consecutive annual Pap tests with normal findings. Two patterns of screening interval use were reported: annual screeners continued performing yearly Pap tests, and selective extended screeners offered an extended interval to select patients. Annual and selective extended screeners reported that both unique and common factors influenced the screening intervals they used. The NBCCEDP has established its cancer screening priorities to focus limited resources on the goal of providing services to eligible women who have rarely or never been screened. Increased efforts are needed to educate physicians about the science supporting an extended Pap screening interval and overcome the barriers associated with its adoption.

Approximately 1 in 3 US adults has hypertension, but only half have their blood pressure controlled. We identified characteristics of health care practices and systems (hereinafter practices) effective in achieving control rates at or above 70% by using data collected via applications submitted from April through June 2017 for consideration in the Million Hearts Hypertension Control Challenge. We included 96 practices serving 635,000 patients with hypertension across 34 US states in the analysis. Mean hypertension control rate was 77.1%; 27.1% of practices had a control rate of 80% or greater. Although many practices served large populations with multiple risk factors for uncontrolled hypertension, high control rates were achieved with implementation of evidenced-based strategies.

What is already known on this topic?The COVID-19 pandemic has caused unprecedented disruptions in routine care and chronic disease management. As hypertension is the most common modifiable risk factor for cardiovascular events, it is imperative that, even during disruptions in care, hypertension control remains a priority. What is added by this report?In response to the challenges presented by COVID-19, clinicians and health care organizations implemented various and unique strategies to respond to patient needs and expand services to monitor hypertension, demonstrating that even during a time of public health crisis, focus on improving hypertension control is possible.What are the implications for public health practice?The findings highlight how health care and public health programs have been able to accelerate innovation and adapt services for continuity of care and hypertension control. This may help inform future efforts to improve health care delivery related to hypertension control, during and after a public health emergency.

No abstract