Breast cancer surveillance: ambulatory care focus in residency may influence practice patterns

Breast cancer causes significant morbidity and mortality in the United States. Early detection of malignant lesions may increase survival rates. Recommended surveillance techniques include breast self-examination, breast examination by a clinician, and mammography. However, results of research suggest that physicians adhere inconsistently to screening guidelines. Residency training has the potential to impact significantly on future practice patterns. This study evaluated the breast cancer screening patterns in women 50 years of age and older by internal medicine resident physicians in a traditional and a primary care residency program from 1988-1994. A retrospective chart review revealed that resident physicians in the primary care residency performed more breast cancer surveillance than residents in the traditional residency for the following techniques: instructions for breast self-examinations, 10.9% vs. 3.6% (P < 0.0007); breast examinations, 81.3% vs. 39.1% (P < 0.00001); mammographies, 93.8% vs. 37.3% (P < 0.00001). This study suggests that the frequency of breast cancer screening by resident physicians may improve with increased ambulatory care experience. Additional study is necessary to identify other factors that could influence preventive care practices.