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How Best to Teach Women Breast Self-Examination: A Randomized Controlled Trial

Suzanne W. Fletcher, MD, MSc; Michael S. O'Malley, MSPH; JoAnne L. Earp, ScD; Timothy M. Morgan, PhD; Shao Lin, MD; and Darrah Degnan, BSc
[+] Article, Author, and Disclosure Information

Grant Support: From the National Center for Health Services Research and Health Care Technology Assessment (RO1HS05184). The cost of all Mammacare instruction equipment, Mammacare training of nurses, and breast models used for outcome measurements was covered in full by research funding. The conduct and analysis of the study was completely independent of Mammatech Corporation, Gainesville, Florida.

Requests for Reprints: Suzanne W. Fletcher, MD, Cancer Prevention Program, CB#7300, Trailer 36 Mason Farm Road, University of North Carolina at Chapel Hill, NC 27599-7300.

Current Author Addresses: Drs. Fletcher and Lin and Ms. Degnan: Cancer Prevention Program, CB#7300, Trailer 36, Mason Farm Road, University of North Carolina at Chapel Hill, NC 27599-7300.

Mr. O'Malley: United Mine Workers of America Health and Retirement Funds, 2021 K Street NW, Washington, DC 20006.

Dr. Earp: Department of Health Behavior and Health Education, School of Public Health, CB#7400, University of North Carolina at Chapel Hill, NC 27599-7400.

Dr. Morgan: Department of Public Health Sciences, Bowman Gray School of Medicine, 300 South Hawthorne Road, Winston-Salem, NC 27103.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;112(10):772-779. doi:10.7326/0003-4819-112-10-772
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Objective: To compare three methods for teaching breast self-examination.

Design: Randomized controlled trial with factorial design.

Setting: A general medicine group practice in a university hospital.

Patients: 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.

Interventions: 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.

Measurements and Main 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 < 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.





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