title: The association between scheduling a gynecologic clinical visit and clinical breast examination in Rio de Janeiro.
abstract: OBJECTIVE
  To investigate factors associated with gynecology health professionals' failure to perform clinical breast examinations (CBEs) during clinical visits.
  
  
  METHODS
  A cross-sectional, interview-based survey was conducted in 2010 among women aged at least 18 years who had undergone a cervical smear in 2007 at primary-care units in Rio de Janeiro, Brazil. Binomial regression was used to generate prevalence ratios and absolute differences between visits for routine examinations or gynecologic complaints.
  
  
  RESULTS
  Analyses included 982 women, of whom 182 (18.5%) did not have a CBE during their visit. Significant interactions were observed between age and primary reason for the visit: the prevalence ratio for no CBE during a visit for gynecologic complaints versus routine examination was 3.2 for women aged at least 40 years, and 1.3 among younger women (P for multiplicative interaction=0.001). Absolute differences were 6.4% and 18.5% for younger and older women, respectively (P for additive interaction=0.04).
  
  
  CONCLUSIONS
  A high proportion of eligible women do not undergo a CBE during cervical smear appointments at primary-care units in Rio de Janeiro, particularly older women presenting with gynecologic complaints. Understanding of health professionals' barriers to following and implementing guidelines for secondary prevention of breast cancer is urgently needed.
authors.affiliation: Post Graduate Program of the Health Collective Studies Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil; Population Research Division of the Brazilian National Cancer Institute, Rio de Janeiro, Brazil. Electronic address: lfmartins@inca.gov.br.
authors.forename: Luís Felipe L
authors.initials: LF
authors.lastname: Martins
authors.affiliation: Population Research Division of the Brazilian National Cancer Institute, Rio de Janeiro, Brazil.
authors.forename: Liz Maria
authors.initials: LM
authors.lastname: de Almeida
authors.affiliation: Population Research Division of the Brazilian National Cancer Institute, Rio de Janeiro, Brazil.
authors.forename: André S
authors.initials: AS
authors.lastname: Szklo
authors.affiliation: Hospital of Rio de Janeiro Federal University, Rio de Janeiro, Brazil.
authors.forename: Helena A
authors.initials: HA
authors.lastname: Tupinambá
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.affiliation: Post Graduate Program of the Health Collective Studies Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil.
authors.forename: Cláudia M
authors.initials: CM
authors.lastname: Coeli
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001938:Brazil; D001943:Breast Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D014626:Vaginal Smears / Q000379:methods; D055815:Young Adult
keywords: Breast neoplasms; Cancer screening program; Clinical protocol adherence; Early detection