) Breast cancer is a common disease in U.S. women. Despite its prevalence, too few physicians regularly promote available screening techniques that could diagnose breast cancer in the pre-clinical stage. Frequently, women say that their doctor did not recommend a mammogram as their reason for not having one done. Furthermore, women say that they have not been adequately instructed or encouraged in breast self-examination. The major focus of this project is educating Family Physicians about breast cancer. Education may have the greatest impact for career practices if given while still in training. Therefore, we have chosen Family Practice Programs in New Jersey as the target group for our educational program. This project is based on a Train-the-Trainer model of physician education that was designed by the National Cancer Institute (NCI) and has been used extensively with smoking cessation. The education program will consist partly of a full-day seminar on """"""""Breast Cancer Screening and Management of a Breast Cancer Diagnosis."""""""" Each of 11 participating Family Practice Residency Programs in New Jersey has committed to sending a minimum of one Clinical Faculty to this Train-the-Trainer breast cancer education seminar. That Faculty Member will be responsible for returning to their own program and disseminating the information to all of the clinical faculty and residents through conferences, workshops and computer-based learning at their own site. A computer-based instructional program will be developed using CD-ROM technology. This will enable residents and faculty to access the breast cancer education according to their own schedule. It will also allow them to review specific information whenever necessary. All programs will be equipped to access Physician's Data Query (PDQ), NCI's comprehensive cancer database. Once the residents and faculty at the Family Practice Residency Programs have been trained, the offices will be randomized into """"""""Specially Mobilized Offices"""""""" or Usual Care Offices."""""""" The doctors at the Usual Care Offices will go about the practice of medicine using their enhanced knowledge about breast cancer, screening and management. The Specially Mobilized Offices will use several behavioral modification components that have been shown to be effective in previous studies. Some examples of these are patient incentives (prizes) to have a mammogram done, chart reminder systems for physicians, patient education materials available on breast cancer screening, making mammogram appointments for patients before they leave, and a computerized reminder/follow-up system to track patients. We will do pre-tests and post-tests of faculty and residents to assess knowledge of breast cancer, frequency of advising screening and skills of performing clinical breast examination and teaching self-breast examination. We will also survey a sample of patients before and after the training to determine their screening frequency, if their doctor has advised them to have a mammogram, and if they have been instructed and encouraged to use self-breast examination.
