An Educational Intervention to Increase Breast Cancer
Screening in a Family Practice Residency
Danice Rinderknecht, M.D. and Georganne Sanders, M.D.
Abstract
Introduction
Breast cancer is the most common cancer in American women. Mammography is the most effective
screening method for early detection of this disease. Early detection leads to early definitive diagnosis,
prompt treatment, and increased survival. The Healthy People 2010 report states that a reduction in the
number of new cancer cases and a reduction in the number of deaths from cancer are two of their major
goals. Their goal for mammography is to increase mammography rates so that at least 70% of women over
age 40 years have had a mammogram in the previous two years. It has been demonstrated that a
curriculum in which physicians receive specific education regarding breast cancer screening significantly
increases the rate of breast cancer screening in residency training and in the future.
Methods
We designed such a program for the Family Practice Residents at Central Maine Family Practice Residency
(CMFPR). We started with standardizing the screening mammography, clinical breast exam (CBE), and
self-breast exam (SBE) guidelines to be used at this training site. We then trained the faculty and clinical
nurse educator who would be teaching the resident staff the standardized technique for performing and
teaching CBE and SBE. The resident staff was required to attend a teaching session on CBE, SBE, and the
utilization of the CMFPR screening mammography guidelines. Residents’ fund of knowledge on the
subject matter was tested with pre- and post-tests and their clinical skills were directly observed. To assess
impact on breast cancer screening in the community, we conducted an initial chart review to determine our
baseline-screening rate, and then performed another chart review six months after the first.
Results/Discussion
Our results demonstrated improved rates in performing clinical breast exams, teaching SBE, recommending
mammograms, and patients actually obtained more mammograms since the implementation of our
educational program. However, we did not make an impact with breast cancer screening in women over
the age of 65 years. There were many confounding variables such as documentation issues, resources, and
other facilities where patients may get their follow up studies, which affected data collection and analysis.
We also recognize that a six-month time period is a short period to assess these behavioral changes and
plan on reviewing the data again after the project has been in place for three years. This intervention
revealed some potential areas for improvement in our current healthcare delivery system, and hopefully
with some adjustments screening rates can be further increased.