H. S. Pennypacker

Clinical Breast Examination: Practical Recommendations for Optimizing Performance and Reporting

Clinical breast examination (CBE) seeks to detect breast abnormalities or evaluate patient reports of symptoms to find palpable breast cancers at an earlier stage of progression. Treatment options for earlier‐stage cancers are generally more numerous, include less toxic alternatives, and are usually more effective than treatments for later‐stage cancers. For average‐risk women aged 40 and younger, earlier detection of palpable tumors identified by CBE can lead to earlier therapy. After age 40, when mammography is recommended, CBE is regarded as an adjunct to mammography. Recent debate, however, has questioned the contributions of CBE to the detection of breast cancer in asymptomatic women and particularly to improved survival and reduced mortality rates. Clinicians remain widely divided about the level of evidence supporting CBE and their confidence in the examination. Yet, CBE is practiced extensively in the United States and continues to be recommended by many leading health organizations. It is in this context that this report provides a brief review of evidence for CBEs role in the earlier detection of breast cancer, highlights current practice issues, and presents recommendations that, when implemented, could contribute to greater standardization of the practice and reporting of CBE. These recommendations may also lead to improved evidence of the nature and extent of CBEs contribution to the earlier detection of breast cancer.

Improved detection of human breast lesions following experimental training

This study was designed to evaluate the effect of breast examination training with silicone models on the detection of lesions in natural breast tissue. Six women with a total of 13 benign breast lumps were examined by 20 trainees before and after a 20–30 minute training session or a period of unrelated activity. Following the training, percentage of correct detections, duration of examination, and reports of false positives increased. Confidence in correct detections and false positives also increased, although confidence in correct detections was greater than confidence in false positives. The results indicate the effectiveness of the training and suggest a need for a more complex model for training discrimination between normal nodularity and breast lesions.

Increased proficiency of search in breast self-examination.

Two experiments were conducted to assess the relative thoroughness of three search patterns for breast self‐examination (BSE). Experiment 1 compared the commonly taught concentric circles (CC) pattern to a new pattern composed of vertical strips (VS). Experiment 2 compared a radial spoke (RS) pattern to the VS pattern. Twenty‐eight female subjects participated in each experiment. Each learned BSE and was post‐tested using the two patterns under investigation; order of presentation was counterbalanced. BSE thoroughness was measured with the aid of a numbered grid projected on the subjects chest allowing an observer to mark each square of the grid palpated on a congruently gridded scoresheet. The percentage of the cone of the breast and of the totality of the breast tissue examined was calculated for each exam. Experiment 1 showed that the VS pattern engendered more thorough coverage of the total breast area (64.4% vs. 38.9%) and of the cone (64.1% vs. 48.7%). The results of Experiment 2 were similar: the VS pattern produced more thorough coverage of the total area (67.9% vs. 44.7%) and of the cone (70.3% vs. 57.2%). All differences were statistically reliable. Of 112 intrasubject comparisons involving the VS pattern, it produced more thorough coverage in all but nine. These results indicate that the VS pattern is the pattern of choice for maximally effective BSE.

Toward an Effective Technology of Instruction in Breast Self-examination

aged 40 to 44 and is the leading cause of cancer deaths in women aged 25 to 74. It is estimated that 1 of every 11 American women will develop breast cancer at some time during her life, about 107,000 new cases being diagnosed in 1980 alone [ 1, 2] . In addition to a profound reduction in life expectancy, victims of breast cancer must also face the prospect of expensive, disfiguring, and often partially disabling surgery. The aggregate cost of breast cancer to our society, in terms of both morbidity and mortality, is impossible to estimate; but any significant reduction in its toll with respect to either of these factors would constitute a major contribution to womens health.

Operant control of vocal behavior in the monkey Cebus albifrons

Vocalizations of three monkeys (Cebus albifrons) were established as operants: they increased in frequency when followed by positive reinforcement and yielded to stimulus control.

Making behavioral technology transferable.

The paucity of transferred behavioral technologies is traced to the absence of strategies for developing technology that is transferable, as distinct from strategies for conducting research, whether basic or applied. In the field of engineering, the results of basic research are transformed to candidate technologies that meet standardized criteria with respect to three properties: quantification, repetition, and verification. The technology of vitrification and storage of nuclear waste is used to illustrate the application of these criteria. Examples from behavior analysis are provided, together with suggestions regarding changes in practice that will accelerate the development and application of behavioral technologies.

Precision Teaching: Foundations and Classroom Applications

Publisher Summary Precision Teaching (PT) is unique between approaches and methods of teaching and education. It has no fixed curriculum, subject-matter areas, types of students, or grade levels. It has been successfully applied with an incredible diversity of students, settings, and learning situations. People who do not practice data-driven decisions and instruction may have a difficult time understanding how precision teachers can verify whether a given curriculum is effective in their classrooms. School curricula typically are selected according to theoretical fads or political expediency, and data-driven evaluation of curricula is superior to those arbitrary processes. When first hearing about PT, many educators cannot imagine how they would operate such a truly individualized system with a whole class of students even if the students did their own charting. In a PT environment, the learner is neither pressured by comparisons to others who may be ahead nor embarrassed by unwelcome use as an example to others who may be behind.

The effects of CS intensity upon learning and performance of the conditioned eyelid response in monkeys

A replication of the design reported by Grice & Hunter (1964) was performed using squirrel monkeys as Ss. In addition, extinction data were collected under a factorial design wherein groups trained to a single intensity CS were subdivided at the beginning of extinction and half of each group shifted to the other value of CS intensity. The results indicate that the within-Ss procedure leads to inferior learning as well as acquisition performance and the learning is superior in the presence of a single soft CS as opposed to a single loud CS.

Progress in manual breast examination

ABSTRACT The scientific history of the MammaCare method of manual breast examination is briefly reviewed. MammaCare instruction involves teaching proper examination technique using silicone models, then transferring that skill to real breast tissue. A computer-based system for teaching the examination technique has been developed and validated and offers savings in personnel time. Its use in Colleges of Nursing is described and data are presented to document its effectiveness.

A magnitude analysis of differential classical, avoidance, and classical-avoidance eyelid conditioning in the monkey (Cebus Albifrons)

Cebus monkeys were subjected to differential classical, differential avoidance, or differential classical-avoidance eyelid conditioning. Conditioning performance was analyzed in terms of both response probability and eyeblink magnitude. The response-probability analysis failed to reveal either acquisition or discrimination under any treatment condition. The magnitude analysis demonstrated differentiation in the within-Ss comparison of the two conditioning paradigms and suggested differentiation in the differential-avoidance group.