Breast self-examination: resistance to change

Area of Science:

• Preventive medicine
• Oncology
• General practice

Background:

• The 2001 Canadian Preventive Health Task Force guideline recommended against routine teaching of breast self-examination (BSE).
• This guideline aimed to align practice with evidence suggesting limited benefit and potential harms of BSE.
• Physician adherence to such evidence-based updates is crucial for effective public health strategies.

Purpose of the Study:

• To evaluate the extent to which Canadian family physicians routinely teach breast self-examination (BSE) post-guideline publication.
• To assess physician awareness of and adherence to the 2001 guideline recommending against routine BSE teaching.

Main Methods:

• A cross-sectional mailed survey was administered to a random sample of English-speaking Canadian family physicians.
• The survey collected data on current and past BSE teaching practices and physicians' opinions on BSE's value.
• Response rate was 47.4%.

Main Results:

• Despite 88% physician awareness of the guideline, only 16% altered their routine BSE teaching practices.
• A significant majority (74.3%) previously taught BSE routinely, and only 9.5% agreed with discontinuing routine teaching.
• Physicians who changed practices were less convinced of BSE's early detection benefits and more concerned about increased benign biopsies.

Conclusions:

• Canadian family physicians demonstrated poor adherence to the evidence-based guideline update on BSE teaching.
• Resistance to guideline adoption may stem from a lack of knowledge, confidence in evidence, or personal clinical experience.
• Further strategies are needed to improve the implementation of evidence-based guidelines in primary care settings.