Do Primary Care Physician Perform Clinical Breast Exams Prior to Ordering a Mammogram?

Abstract

Both the American Cancer Society and National Comprehensive Cancer Network recommend annual clinical breast examination (CBE) along with screening mammogram (SM) for patients starting at 40 years of age. However, patients with a palpable breast mass should have a diagnostic mammogram (DM) during workup. Review at our institution demonstrated that 11% of patients with newly diagnosed breast cancer and self-identified breast mass had SM instead of DM. This led us to question whether primary care physicians (PCP) perform CBE prior to ordering mammography. As part of the routine preimaging screening, patients were asked if they had undergone breast examination by a medical provider prior to mammogram order. Data on mammogram type, ordering physician specialty, and presence of symptoms on day of mammogram were recorded. Of 6,109 mammograms, 4,823 were ordered by PCPs. CBE was performed prior to 67.2% SM and 64.8% DM (p = 0.12). OB/GYN performed statistically significantly higher CBE (81.6%) compared to internal (45.4%) and family (50.5%) medicine physicians (p < 0.001). Of patients with self-reported breast symptoms, 8.7% had SM ordered rather than DM. Despite recommendations, approximately 1/3 of women report not having CBE prior to mammogram. The chances of having a CBE varied significantly by PCP specialty. Lack of CBE can lead to incorrect type of mammogram, with possibly increased cost and delay in diagnosis. Further evaluation is needed to understand why CBE was not performed in some patients.

Factors influencing delay in symptomatic presentation of breast cancer in Brazilian women

“…In Brazil, strategies for early breast cancer diagnosis must take a three‐pronged approach comprising a population aware of the signs and suspicious symptoms of the disease, health professionals qualified to evaluate even difficult‐to‐detect cancer cases and qualified health services, in order to guarantee integral medical assistance (Brasil, ). It is possible to assess facilitators regarding this process, during gynaecological consultations, as health professionals may promote education and awareness actions directed to interventions, such as clinical breast exams and mammograms (Larson, Cowher, O'Rourke, Patel, & Pratt, ). Because of this, it is supposed that women who frequently attend gynaecological consultations are more likely to detect breast cancer in its early stages (Azenha et al, ; Larson et al, ).…”

“…It is possible to assess facilitators regarding this process, during gynaecological consultations, as health professionals may promote education and awareness actions directed to interventions, such as clinical breast exams and mammograms (Larson, Cowher, O'Rourke, Patel, & Pratt, 2016). Because of this, it is supposed that women who frequently attend gynaecological consultations are more likely to detect breast cancer in its early stages (Azenha et al, 2011;Larson et al, 2016). American researchers TA B L E 3 Factors to the delay in symptomatic presentation on women's perception (data from 182 women who thought that there was a delay) concluded that women who do not frequently use health services and seek out less preventive attention are more prone to delays in presentation (Rauscher et al, 2010).…”

Examining Breast Cancer Screening Behavior Among Southern Black Women After the 2009 US Preventive Services Task Force Mammography Guideline Revisions

“…8,36 This suggested that our sample was not following older screening recommendations across cancer sites/breast cancer screening behaviors but receiving clinical breast exams and possibly mammography referrals during annual visits with their primary care providers. 47,48 However, it is not clear whether Black women are receiving guidance that reflects pre-USPSTF recommendations or no screening recommendation at all during these encounters. Research has documented that providers are less likely to recommend mammography screening to Black women compared to their White patients.…”

Reasons for not participating in breast cancer screening, ways to obtain information and measures to improve participation in screening

“…One of the most effective measures to reduce breast cancer mortality is early detection (Amasha 2013;Larson et al 2016;O'Mahony et al 2017;Somayyeh and Aydogdu 2019). Breast cancer research, early detection and treatment have increased the survival rate of cancer patients, but not the incidence of breast cancer.…”