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Original Research |

Breast Symptoms among Women Enrolled in a Health Maintenance Organization: Frequency, Evaluation, and Outcome

Mary B. Barton, MD, MPP; Joann G. Elmore, MD, MPH; and Suzanne W. Fletcher, MD, MSc
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From Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts; and University of Washington School of Medicine, Seattle, Washington.

Ann Intern Med. 1999;130(8):651-657. doi:10.7326/0003-4819-130-8-199904200-00005
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Background: Few data exist about visits to primary care clinicians for breast symptoms in the United States.

Objective: To determine how often women present with breast symptoms, how these symptoms are evaluated, and how often cancer is diagnosed.

Design: Retrospective cohort study.

Setting: Staff-model division of a large health maintenance organization (HMO) in New England.

Patients: 2400 women who were 40 to 69 years of age as of 1 July 1983 and were continuously enrolled in the HMO until 30 June 1995.

Measurements: Information on all breast-related encounters from 1 July 1983 to 30 June 1993 was abstracted. Type of symptom, clinicians' findings and recommendations, and all subsequent evaluations were recorded. Cases of cancer diagnosed subsequent to the symptom were determined.

Results: Sixteen percent of the HMO population presented with a breast symptom during the 10-year period, for a rate of 22.8 presentations per 1000 person-years. Women younger than 50 years of age presented nearly twice as often as older women (P = 0.001). Women with breast symptoms had lower rates of screening than other women before presenting but higher rates of screening afterward (P < 0.001). Symptoms were evaluated beyond the initial visit in 66% of patients, and invasive procedures were performed in 27% of patients. Cancer was found in 6.2% of patients and 4.5% of episodes; rates of cancer detection varied significantly by type of symptom but not by patient age.

Conclusions: Breast symptoms among women 40 to 70 years of age were common in this primary care practice. Evaluation beyond initial examinations was frequent, and invasive procedures were performed for 27% of patients. Cancer was diagnosed in more than 4% of episodes, indicating that follow-up of breast symptoms is important in primary care practices.





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