Optimization of clinical breast examination

Area of Science:

• Oncology
• Medical Quality Improvement
• Clinical Practice

Background:

• Mammograms miss 8-17% of breast cancers, necessitating clinical breast examination.
• Breast examinations are performed less frequently and effectively.
• Improving breast examination quality is crucial for early cancer detection.

Purpose of the Study:

• To determine if focusing clinician attention can improve breast examination quality.
• To assess the impact of dedicated forms on the call rate without retraining.

Main Methods:

• Clinicians were randomized to use either a long or short dedicated form after routine breast examinations.
• No retraining in breast examination techniques was provided.
• Call rates from the study were compared to historical controls.

Main Results:

• The call rate significantly increased from 4.7% to 8.3% when dedicated forms were used.
• This improvement suggests a Hawthorne effect, where the act of data collection influenced outcomes.
• Four cancers were detected in 1822 patients, aligning with predictions.

Conclusions:

• Using a dedicated form to focus attention on breast examination findings doubled the call rate.
• Clinician attention, not technique retraining, improved breast examination quality.
• This method enhances the effectiveness of clinical breast examinations.