title: Breast self-examination: who teaches it, who is taught, and how often? (United States).
abstract: BACKGROUND
  Although the effectiveness of breast self-examination (BSE) has not been established, it is widely practiced and taught. However, it is not clear which patients and providers are involved in BSE teaching, nor how often it occurs. We undertook this study at a large New England Health Maintenance Organization (HMO) to answer these questions.
  
  
  METHODS
  The study was a retrospective cohort of 2242 randomly selected women aged 40-69 with no history of breast cancer and at least one screening clinical breast examination, followed over a ten-year period, including their medical providers (n = 356). Data were collected via computerized medical records.
  
  
  RESULTS
  Sixty-eight percent of women had documented BSE teaching at least once in the ten years, increasing from 13% taught in 1983 to 36% in 1993 (p = 0.001). Teaching was related to younger age, increasing numbers of clinical breast examinations, screening mammograms, and prior BSE teachings. Patient race, income, family history of breast cancer, and estrogen replacement use were not related to teaching. Sixty-one percent of all providers taught BSE at least once during the ten years. Internists (OR 6.37, 95% CI 2.23-17.3) and non-physician providers (OR 12.8, 95% CI 3.0-54.4) were more likely to teach at least half of their patients than were obstetrician-gynecologists. Recent medical school graduates taught BSE more often. Provider gender was not associated with teaching.
  
  
  CONCLUSIONS
  Over two-thirds of women patients in this HMO setting were taught BSE and the majority of providers taught BSE at least once during the ten years. Rates of teaching tripled over the decade. It is important to establish the effectiveness of BSE and its appropriate role in breast cancer screening.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School Pilgrim Health Care, Boston, MA 02215, USA. larissa_nekhlyudov@harvardpilgrim.org
authors.forename: Larissa
authors.initials: L
authors.lastname: Nekhlyudov
authors.forename: Mary B
authors.initials: MB
authors.lastname: Barton
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
authors.forename: Suzanne W
authors.initials: SW
authors.lastname: Fletcher
mesh_terms: D000328:Adult; D000368:Aged; D016504:Breast Self-Examination / Q000592:standards / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006282:Health Personnel; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D009511:New England; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D012189:Retrospective Studies