Freund K M, Burns R B, Antab L
Women's Health Unit, Evans Department of Medicine, Boston Medical Center, Massachusetts 02118, USA.
J Cancer Educ. 1998 Spring;13(1):20-5. doi: 10.1080/08858199809528506.
Clinical breast examination and mammography are recommended as combined modalities for breast cancer screening. Rates of mammography are increasing; however, clinical breast examination rates are decreasing. Specific training in breast examination may be warranted.
The authors developed an ambulatory rotation to teach breast cancer screening to medical residents. To assess whether this training improved screening performance, they compared clinical breast examination and mammography rates in residents' continuity clinics before and after training among residents who were assigned to the training program and residents who were not.
314 women patients were seen by 28 residents. The rates for annual clinical breast examination and mammography were 39% and 71%, respectively. Clinical breast examination rates increased by 18% among the residents assigned to the training program, whereas they dropped by 13% over than same period among the residents who had not received the training (p < 0.005). Female residents performed more clinical breast examinations than did their male counterparts (50% vs 34% p < 0.01). Mammography rates did not change with training, and were not associated with resident gender or career plans.
Although the residents performed mammography at high rates, clinical breast examination rates were low. Short-term directed teaching about clinical breast examination increased the performance of this screening test, and is important to incorporate into teaching programs.
临床乳腺检查和乳房X光检查被推荐作为乳腺癌筛查的联合方式。乳房X光检查的比例在上升；然而，临床乳腺检查的比例却在下降。可能需要进行乳腺检查的专项培训。
作者开展了一个门诊轮转项目，向医学住院医师传授乳腺癌筛查知识。为评估该培训是否提高了筛查表现，他们比较了分配到培训项目的住院医师和未分配到培训项目的住院医师在培训前后其连续性诊所中的临床乳腺检查和乳房X光检查比例。
28名住院医师共诊治了314名女性患者。年度临床乳腺检查和乳房X光检查的比例分别为39%和71%。分配到培训项目的住院医师的临床乳腺检查比例增加了18%，而同期未接受培训的住院医师的该比例下降了13%（p < 0.005）。女性住院医师进行的临床乳腺检查比男性住院医师更多（50%对34%，p < 0.01）。乳房X光检查比例并未因培训而改变，且与住院医师的性别或职业规划无关。
尽管住院医师进行乳房X光检查的比例很高，但临床乳腺检查比例较低。关于临床乳腺检查的短期定向教学提高了该筛查测试的表现，将其纳入教学项目很重要。
