[Routine breast examination and early detection of hypertension and diabetes mellitus by primary care physicians ].

Breast cancer is the leading cause of cancer mortality among women is Israel. On average, 1 in every 12 women develops the disease. While breast self-examination has not proved effective, and routine mass mammography is at present unavailable to the population at large, regular routine breast examination by primary care physicians can effectively screen a large fraction of this country's population. In order to do so, full acceptance of the procedure by women and their physicians is required. This study examines the attitudes and practice of primary care physicians with regard to routine breast examination, and compares them with routine detection of hypertension and diabetes mellitus. A structured questionnaire was distributed to all 97 Kupat Holim (workers' federation sick fund) primary care physicians in the Negev. They included 40 family physicians (FP), board-certified or completing specialization, and 57 general practitioners (GP), not board-certified. There was no difference in response rate between the 2 groups (47%). Nearly all physicians perform routine examinations for detection of hypertension (100% of the FP and 96% of the GP) and diabetes mellitus (91% and 74%, respectively). Of the FP, 96% consider routine breast examination as the task of the primary care physician, versus only 68% of the GP. Accordingly, 92% of the FP stated that they routinely perform the procedure, but only 52% of the GP. Being an FP was positively related with the performance of breast examination, while seeing a large number of patients per clinic session and low job satisfaction were negatively associated with it.

Workload involved in routine breast examination and instruction in breast self-examination in the primary care clinic.

This study evaluates the impact of breast examinations and instruction in breast self-examination as a routine for women aged 30 years and over on the workload in a primary care clinic of the Workers' Sick Fund (Kupat Holim) in Israel. It covers a three-year period from 1977 to 1980. Clinic sessions of four hours duration with an average of 21 patients each were held five times a week. Women who were considered high risk for breast cancer were to be examined twice a year, low risk women once a year. A first breast examination with instruction required on average 10 minutes, a subsequent examination seven minutes. A total of 696 breast examinations were performed, averaging 1.2 breast examinations per clinic session. This resulted in a maximum extra workload of 12 minutes per clinic session of four hours.