Portland, Ore.

Program receives multiple grants and replication

While breast cancer remains the most common cancer among American women -- and the second leading cause of cancer deaths in women -- most physicians report they have received little, if any, instruction on how to conduct a complete breast exam. Oregon Health & Science University may be the first academic health and research center to change that status quo.

"When a woman walks out of her clinician's office, she expects her breast exam to be complete. If nothing was found, she believes she does not have cancer," said Nancy Prouser, M.S., clinical breast exam (CBE) training program director at the OHSU Cancer Institute. "But according to research on what provides the most comprehensive exam -- the exam that will pick up the most breast lumps and miss the least -- most women in Oregon and across the country are simply not receiving complete exams."

In fact, the breast exam method proved to most effective in detecting breast lumps by Harvard researchers in the Journal of the American Medical Association has been taught to practicing clinicians by OHSU faculty for years. But now, for the first time, the OHSU Cancer Institute's breast exam program has been offered three grants to teach the method to medical students and residents as well. Prouser also expects the technique to be recommended as the nationally standardized exam model by the American Cancer Society.

Prouser works with Donald Austin, M.D., M.P.H., professor of public health and preventive medicine in the OHSU School of Medicine. He is principal investigator for the program's new $250,000 Centers for Disease Control and Prevention (CDC) grant. This grant is aimed at teaching OHSU medical students the standardized, optimal breast exam method. Austin is also principal investigator for a $25,000 OHSU Medical Research Foundation grant to create a pilot study examining the program's outcome data.

Additionally, the Northwest Health Foundation awarded the program $75,000 so trained faculty can teach the exam technique to all adult primary care residents throughout Oregon. The CDC and American Cancer Society also recently have convened a consensus group to study clinical breast exams and make recommendations on how to conduct breast exams in the most effective, consistent manner nationwide. OHSU is the only academic program whose current training program matches what the consensus group is expected to recommend.

The Cancer Institute's unique exam technique is the result of evidence-based research that reveals breast exams should include proper positioning of the patient, methodical thoroughness, a "vertical-strip" pattern (as opposed to a circular or wedge technique), correct finger movements and a comprehensive area of coverage. All these components are hallmarks of OHSU's program.

While other states may use one or more aspects of this method, Oregon is the only state that will be teaching the comprehensive, standardized clinical breast exam approach, including both didactic and hands-on teaching to medical students, residents and practicing clinicians. Although more than 500 practicing clinicians across the state have participated in the course to date, teaching medical students and residents before they go into practice offers a more productive way to ensure all new clinicians learn a uniform exam, one that benefits patients well into the future. For the first time, the CDC and Northwest Health Foundation grants will allow this. The CDC hopes the OHSU Cancer Institute's results will prove so effective that the method will be used as a model across the nation. The program also plans to bring the technique to participants all over the country and the Pacific Rim through a new training center.

"We know our method results in practitioners finding more lumps on breast models than practitioners trained through standard methods," Prouser said. "Now we'll see whether it helps providers find breast cancer earlier and more effectively. Because of our experience and success teaching clinicians across the state, and because we're in an academic setting, we're definitely the right program to do this."

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