Following up abnormal breast cancer screening results: lessons for primary care clinicians.

Good primary care now includes routine screening for breast cancer among appropriate age-groups of women patients. Virtually all expert groups recommend breast cancer screening. During the past several decades, these recommendations have been translated into increasingly higher percentages of women getting breast cancer screening. 1-3 By 1995, a national study found that 70% of women aged 40 years and older reported receiving a mammogram in the previous 2 years. 1t is likely that the increasing amount of breast cancer screening in the United States is one reason for the 6% drop in breast cancer mortality between 1990 and 1994.4 The extent of breast cancer screening a woman receives can vary according to the specialty of her physician. Finison and colleagues looked at Medicare Part B claims during 1993 and 1994 in New England and found that 55% of women aged 65 to 69 years received mammography in the previous 2 years: 78% of women cared for by gynecologists, 67% by internists, 58% by family physicians, 47% by general practitioners, and 41 % by other specialists. Although primary care clinicians are incorporating routine breast cancer screening more and more, these data suggest there is still room for improvement, at least among older women. With breast cancer screening rates on the rise, attention is turning to follow-up of abnormalities detected during screening, the focus of the study by Schootman et al in this issue of The Journal. Guidelines for follow-up were issued in 1995 by a joint committee of The Society of Surgical Oncology, the Commission on Cancer of the American College of Surgeons, and the Centers for Disease Control and Prevention, and more recently by a Canadian consensus effort of the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer.8 Determining how often the screening test is abnormal is complicated by the fact that more than