0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

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
[+] Article and Author Information

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
Text Size: A A A

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.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)