A Touchy Subject: Patient Perceptions of Clinical Breast Exams [ID 1257]

INTRODUCTION: Clinical breast exams (CBEs) have long been considered a routine part of care, but guidelines on their use vary: the American Cancer Society no longer recommends routine CBEs; the National Comprehensive Cancer Network supports them when feasible for women over 25; the American College of Obstetricians & Gynecologists advises shared decision-making; and the United States Preventive Services Task Force makes no mention of CBEs. This study explores the patient experience of CBEs in the setting of variable guidelines and provider practice. METHODS: This IRB-approved study administered a 40-question (Qualtrics) survey to patients at a single academic medical center over the age of 25 and at a normal risk of breast cancer. After obtaining informed consent, surveys characterized 1) demographics, 2) experiences of routine breast examinations, 3) knowledge of current breast examination guidelines, and 4) preferences for future breast examinations in light of current guidelines. RESULTS: Of 2,343 surveys sent, 887 eligible responses were received. A CBE was performed at the last health maintenance exam for 59% of respondents, and 55% reported receiving CBEs annually. The majority (83%) of respondents viewed CBEs as an important part of health maintenance, and 73% believed they should be performed annually. After reviewing conflicting guidelines, 57% still preferred to receive yearly CBEs. Despite this preference, 47% of respondents reported feeling somewhat to extremely uncomfortable during the exam. CONCLUSIONS/IMPLICATIONS: In the setting of unclear guidelines, most patients reported receiving and preferring annual CBEs, viewing them as an important part of preventive care. Nevertheless, nearly half experienced discomfort, highlighting the need for patient-centered, shared decision-making when determining the role of CBEs in routine care.