Limited adoption of current guidelines for clinical breast examination by primary care physician educators

In 2004, the CDC and the American Cancer Society (ACS) published performance guidelines recommending a validated method of clinical breast exams (CBE) using the vertical strips method (VSM) along with other key exam components. We examined the use of the VSM by academic medicine physicians and identified predictor variables for its adoption.

Clinician educators in the Society of General Internal Medicine (SGIM) and physicians in the Society of Teachers of Family Medicine (STFM) were administered web-based surveys on CBE practices in 2009.

A total of 1,772 (42%) physicians responded. Only 40% of respondents reported using the VSM, compared with 53% using the circular search method. Variables and their odds ratios (ORs) associated with an increase adoption of the VSM were having a primary teaching hospital affiliation (OR 1.4 [1.1, 1.9]), having taken a course on breast health or breast cancer in the past 5 years (OR 1.5 [1.1, 2.0]), and having completed residency in the past 5 years (OR 2.3 [1.6, 3.4]) and/or 10-15 years (OR 1.6 [1.2, 2.2]) compared to more than 15 years. The extent of teaching responsibilities was not associated with adoption of the VSM.

A majority of physician responders highly involved in education of students and residents continue to practice methods of CBE that do not reflect the current guidelines. Faculty development and training on updated CBE practices may accelerate adoption of guideline-recommended care.