Singh Gitika N, Agarwal Aastha, Jain Vinod, Kumar Priti
Department of Surgery, King George's Medical University, Lucknow, U.P, India.
Department of Obstetrics and Gynecology, Sunflower Medical Centre, Lucknow, U.P, India.
World J Surg. 2019 Jan;43(1):183-191. doi: 10.1007/s00268-018-4740-5.
The knowledge of breast cancer risk factors and screening practices in a community is largely influenced by the practising gynaecologist in that area. We assessed the understanding and knowledge of gynaecologists about breast cancer: screening, risk factors, clinical signs, management and common benign breast diseases.
This cross-sectional study was carried out in Uttar Pradesh, India, from April to September 2017. One hundred and fifty-two gynaecologists were assessed using a self-designed and validated questionnaire to assess the knowledge of risk factors, clinical signs, screening practices and management of breast cancer as well as common benign breast diseases. Further, the results were compared based on their education: undergraduates (UGs; no residency experience in obstetrics and gynaecology) versus postgraduates (PGs; residency experience in obstetrics and gynaecology).
67 and 82.2% of gynaecologists possess excellent to very good knowledge of risk factors and clinical signs of breast cancer, respectively. The knowledge of PGs seems to be better than UGs (p < 0.01). 84.9% participants were aware that breast cancer screening decreases breast cancer-related mortality, and 61.2% considered CBE as most relevant screening investigation (66.1% PGs and 41.9% UGs; p = 0.04). 30.2% regularly offer breast cancer screening at their centre. 58.5% did not consider screening mammography as cost-effective for their patients (57.9% PGs and 61.3% UGs; p = 0.72), and 41.4% considered it to be a time-consuming process (39.7% PGs and 48.4% UGs; p = 0.38). 99.3% like to follow up a patient with familial breast cancer by themselves, and 0.7% like to refer them to specialist. 51.9% gynaecologists were convinced of breast conservation surgery (BCS) as a surgical option, however 51.3% feared leaving diseased breast behind.
Despite the knowledge regarding risk factors, clinical signs and treatment of breast cancer and benign breast diseases was found adequate amongst the gynaecologists, this did not apply to their clinical practice. Structured and continuous training of gynaecologists is needed to improve the outcome of patients with breast diseases in terms of better management and reference.
某社区对乳腺癌风险因素及筛查措施的认知很大程度上受该地区执业妇科医生的影响。我们评估了妇科医生对乳腺癌的了解情况，包括筛查、风险因素、临床体征、治疗以及常见的乳腺良性疾病。
这项横断面研究于2017年4月至9月在印度北方邦开展。采用自行设计并经验证的问卷对152名妇科医生进行评估，以了解他们对乳腺癌风险因素、临床体征、筛查措施、治疗以及常见乳腺良性疾病的认知。此外，根据他们的学历进行结果比较：本科毕业生（未接受过妇产科住院医师培训）与研究生（接受过妇产科住院医师培训）。
分别有67%和82.2%的妇科医生对乳腺癌风险因素和临床体征有优秀至良好的认知。研究生的认知似乎优于本科毕业生（p < 0.01）。84.9%的参与者知晓乳腺癌筛查可降低乳腺癌相关死亡率，61.2%认为临床乳腺检查是最相关的筛查手段（研究生为66.1%，本科毕业生为41.9%；p = 0.04）。30.2%的人在其所在中心定期开展乳腺癌筛查。58.5%的人认为乳腺钼靶筛查对其患者而言不具有成本效益（研究生为57.9%，本科毕业生为61.3%；p = 0.72），41.4%的人认为这是一个耗时的过程（研究生为39.7%，本科毕业生为48.4%；p = 0.38）。99.3%的人希望自行随访家族性乳腺癌患者，0.7%的人希望将他们转诊给专科医生。51.9%的妇科医生认可保乳手术作为一种手术选择，然而51.3%的人担心残留患病乳房。
尽管发现妇科医生对乳腺癌及乳腺良性疾病的风险因素、临床体征和治疗有足够的认知，但这在他们的临床实践中并未得到体现。需要对妇科医生进行结构化的持续培训，以便在更好的管理和转诊方面改善乳腺疾病患者的治疗效果。
