title: Breast self-examination: resistance to change.
abstract: OBJECTIVE
  To investigate whether Canadian family practitioners routinely teach breast self-examination (BSE) after publication of the 2001 Canadian Preventive Health Task Force guideline advising them to exclude teaching BSE from periodic health examinations.
  
  
  METHODS
  Self-administered cross-sectional mailed survey.
  
  
  METHODS
  Canada.
  
  
  METHODS
  A random sample of English-speaking general practitioners and physicians certified by the College of Family Physicians of Canada.
  
  
  METHODS
  Current and past BSE practices and opinions on the value of BSE.
  
  
  RESULTS
  Response rate was 47.4%. Most respondents (88%) were aware of the new recommendations, yet only 16% had changed their usual practice of routinely teaching BSE. Most physicians agreed that before the recommendation they almost always taught BSE (74.3%). Only 9.5% agreed that physicians should follow the recommendation and not routinely teach BSE. A few also agreed that they now spend less time discussing BSE (25.7%) and that the recommendation has influenced them to stop teaching (12.4%) and encouraging (12.9%) women to practise BSE. Physicians who had changed their BSE practices were less likely to agree that BSE increases early detection of breast cancer and more likely to agree that BSE increases benign breast biopsies. They were also more likely to agree that screening mammography in women older than 50 decreases mortality from breast cancer.
  
  
  CONCLUSIONS
  This survey, which assessed routine teaching of BSE, revealed poor adherence by Canadian family physicians to a well publicized evidence-based guideline update. Resistance to change could in part be attributed to a lack of knowledge of the supporting evidence, a lack of confidence in the evidence to date, and personal experiences with patients within their practices.
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Ontario. lisa.delgiudice@sw.ca
authors.forename: M Elisabeth
authors.initials: ME
authors.lastname: Del Giudice
authors.forename: David
authors.initials: D
authors.lastname: Tannenbaum
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Goodwin
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis; D016504:Breast Self-Examination / Q000706:statistics & numerical data*; D002170:Canada; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D010821:Physicians, Family; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*