EFFECT OF BREAST-TISSUE CHARACTERISTICS ON THE OUTCOME OF CLINICAL BREAST EXAMINATION TRAINING

Purpose. To compare the effects of clinical breast examination (CBE) t raining on lump-detection rates in simulated premenopausal and postmen opausal breast tissue. Method. Two sets of six silicone models were ma de with background breast tissue simulating premenopausal tissue (most nodular, least soft) and postmenopausal breast tissue (least nodular, most soft) respectively. Eighteen lumps were located in each set of m odels. In September 1994, 82 housestaff and attending physicians with outpatient practices in the Division of General Internal Medicine at N orthwestern University Medical School were randomized to a CBE-teachin g intervention or a control group. Lump-detection rates for the two se ts of models were measured before and after the teaching intervention. Analysis of covariance was used to analyze the effect of CBE training on examination sensitivity and specificity, controlling for baseline rates. Results. CBE training increased lump-detection rates similarly and significantly in models simulating premenopausal and postmenopausa l tissue, respectively. Specificity declined after training in models simulating postmenopausal tissue (p = 0.02) but was unchanged in model s simulating premenopausal tissue (p = 0.54). CBE training had greater influence on sensitivity among housestaff than among attending physic ians (p = 0.02) Conclusion. CBE training similarly affects lump detect ion in simulated premenopausal and postmenopausal breast tissue, but a dversely affects specificity in simulated postmenopausal tissue only.