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Breast Symptoms in a Health Maintenance Organization
Mary Barton, MD, MPP;
Suzanne Fletcher, MD, MSc; and
Joann Elmore, MD, MPH
7 December 1999 | Volume 131 Issue 11 | Pages 865-866
IN RESPONSE:
Drs. Stefani and Cadore raise two interesting questions. We drew no conclusions regarding the appropriateness of patients presenting to internal medicine departments; our finding that 71% of initial symptoms were brought to clinicians in internal medicine probably reflects a culture wherein the first contact is with an identified primary care provider; this is also seen in countries other than the United States (1). As we noted in our article, rates of presentation of breast symptoms did not differ by ethnic group, although presenting with a breast symptom was more likely in patients with a family history of breast cancer.
We agree that it would be interesting to know how clinicians document information on breast cancer risk factors. However, although the clinical factors (obesity, breast density, and estrogen replacement therapy) mentioned are known to be correlated with breast cancer risk in the general population, no data suggest that the presence or absence of these risk factors would modify the probability that a woman presenting with a symptom has breast cancer. Our study showed that any symptom significantly increased the likelihood that a woman had cancer over the baseline risk in the population; this suggests that all breast symptoms should be taken seriously.
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Author and Article Information
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Harvard Pilgrim Health Care; Boston, MA 02215 (Barton)
Harvard Pilgrim Health Care; Boston, MA 02215 (Fletcher)
University of Washington; Seattle, WA 98195 (Elmore)
1. Roberts MM, Elton RA, Robinson SE, French K. Consultations for breast disease in general practice and hospital referral patterns Br J Surg. 1987;74:1020-2.[Medline]
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Breast Symptoms among Women Enrolled in a Health Maintenance Organization: Frequency, Evaluation, and Outcome
Mary B. Barton, Joann G. Elmore, AND Suzanne W. Fletcher
- Annals 1999 130: 651-657.
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