NEW HANOVER BREAST CANCER SCREENING PROGRAM

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We propose a comprehensive program to increase and improve breast cancer screening (BCS), including annual clinical breast examination and mammography among women ages 50 to 74 in New Hanover County, NC. The program will be coordinated by a committee of local medical leaders and the project investigators. Interventions will be aimed at 1) Primary Care Physicians, 2) Radiologists, and 3) Community Women ages 50 to 74. For physicians, an educational meeting focusing on the need for mammography, training sessions for improved performance of the clinical breast examination, and adoption of a prompting system to remind physicians to perform BCS will be introduced. UNC radiologists will work with local radiologists to establish ongoing quality assurance systems for mammography. Radiologists and local medical leaders will work to make high quality mammography available at lower charges. Finally, a Community Invention will increase women's awareness and use of BCS with a mass media compaign. In addition, a patient-prompting program using written material (pamphlets, posters, and cards) will remind patients to ask their physicians about BCS. Each of the interventions will be developed in a modular fashion so that if useful, it can be used in other communities around the country. Evaluation will include pre- and post-test measurements in New Hanover Country and a control community, Pitt County: 1) A telephone survey of women ages 50 to 74 to determine the percentage who have received BCS in the previous year; 2) A telephone survey of physicians, to determine knowledge/attitudes towards BCS; 3) Assessment of breast lump detection competency of physicians, using manufactured silicone breast models; 4) Review of medical records to determine frequency of BCS in physicians' practices; 5) Documentation of the number and cost of mammograms performed and the existence/extent of quality assurance for mammography in radiology units; and 6) Review of local hospital pathology reports to document the pathological stage of all newly diagnosed breast cancers.