How best to teach women breast self-examination. A randomized controlled trial.
OBJECTIVE
To compare three methods for teaching breast self-examination.


METHODS
Randomized controlled trial with factorial design.


METHODS
A general medicine group practice in a university hospital.


METHODS
Continuing-care patients from 40 to 68 years of age. Of 456 eligible women, 156 refused participation, 300 were randomly assigned, 269 completed assigned interventions, and 260 completed the post-test 1 year later.


METHODS
One third of patients received nurse instruction stressing tactile skills (Mammacare group) (Mammatech Corporation, Gainesville, Florida); one third, traditional nurse instruction emphasizing technique (traditional group); and one third, no nurse instruction (control group). Half of each group received physician encouragement.


RESULTS
One year later, women in the Mammacare group found more lumps (mean, 57%; 95% CI, 54% to 60%) in manufactured breast models than did those in the traditional (mean, 47%; CI, 44% to 51%) and control (mean, 45%; CI, 42% to 48%) groups. Lump detection specificity was unaffected. Self-reported examination frequency rose in all groups, to 5.1 times per 6 months in the traditional group, 4.2 in the Mammacare group, and 3.9 in the control group. Physician encouragement did not improve sensitivity, specificity, or overall frequency. Women in the Mammacare group used more of seven examination techniques (4.9) than did those in the traditional (3.9) or control (3.2) groups (P less than 0.001). No group increased health care use or reported more overall worry about breast cancer.


CONCLUSIONS
Mammacare instruction resulted in more long-term improved lump detection and examination technique use than did traditional instruction or physician encouragement. Breast self-examination instruction should emphasize lump detection skills.
Fletcher
S W
SW
School of Medicine, University of North Carolina, Chapel Hill.
O'Malley
M S
MS
Earp
J L
JL
Morgan
T M
TM
Lin
S
S
Degnan
D
D
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000517:prevention & control*; D004521:Educational Measurement; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009740:Nursing Staff; D010173:Palpation / Q000379:methods / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods*; D010819:Physician's Role; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D012680:Sensitivity and Specificity; D013663:Teaching / Q000379:methods