Timely discovery and management of the disease of the breast – the recommended method for practitioners in the Czech Republic. Is the formation and implementation of the method effective

Mudr. Zuzana Miškovská, co-author of the recommended method

General Practitioner Association, Czech Medical Association of Jan Evangelista Purkyne (Česká lékařská společnost Jana Evangelisty Purkyně) initiated in the year 2002 the creation of the center for creation and maintaining the recommended methods for general practitioners. The formation of recommended methods involves the representatives of other medical specializations from other professional organizations. The aim of the Czech Medical Association of JEP is the formation and regular updates of methods for diagnosis and treatment of those diseases that have a high morbidity/mortality rate and/or have high treatment costs.

In between such diseases in the Czech Republic is breast cancer. In the year 2000, there were 2000 dead women to this form of cancer. Therefore a high significance is merited to the beginning of the project Screening Mammography. It was placed in the legislature in the year 1997; the program was launched in the year 2002. Currently there is a network of 56 accredited (and regularly reaccredited) mammographic centers. After four years of the ongoing project the morbidity rates have stopped on late stage forms of breast cancer and in some regions the curve for cancer diagnosed in the primary stage has crossed with the curve for the late stage cancers. Nevertheless the participation of women (according to regions between 35-50% of the target populace) in screening isn’t so favorable as in the Scandinavian countries.

The recommended method “Timely discovery and management of the diseases of the breast” among other things determines the place and function of the general practitioner in the screening process.

The author of the recommended method was interested, how effective was the implementation and how might the involvement of women be increased.

At the conference of Czech Medical Association, which was held in November 2006 in Karlovy Vary, independent consultants turned to the general practitioners with the following questions:

Basic questions:

1. Did the DP - Timely discovery and management of the disease of the breast provide you with new information?
2. Did the “Recommended methodology” change your approach to preventive check-ups of women in your practice?
3. Did you know the morbidity of breast cancer in your region before the creation of the DP?
4. Do you use the interview with women in your practice to talk about breast cancer?
5. Do you use in your practice the cooperation of your nurse for greater compliance of women with the demands of screening?

Follow-up questions:

1. How old are you?
2. How many residents are in your home town?
3. Are you a woman?
4. Would you welcome practical education in the form of “exemplary examination and interview” with a woman before mammography?

Do you wish to receive regular information about this topic? On which address?

Evaluation: 
POSITIVE EFFECTS: 
For 90% of those interviewed the recommended approach had a consequence of providing new information.

80% of those interviewed had known before the implementation and publication of the recommended method the real morbidity and mortality rates of breast cancer in their region, now the awareness is greater.

Most of those interviewed talk about breast cancer with women in their preventive check-ups. Answers had not changed with the size of the town where the practitioner resides – a good sign that the lectures on recommended procedures are well accessible.

Answers were well balanced with respect to the sex of those interviewed. The skeptical prediction that male doctors would be ashamed or demure from the topic was not confirmed.

NEGATIVES: 
Not all doctors utilize the aid of the nurse in this topic. Usually it is the nurse that is closer psychologically to the patient, can interpret the opinions and recommendations of the doctor to be more comprehensible to the patient, and the patients usually establish a closer tie to the nurse. That is the reason that now there is a cycles of workshops for nurses in primary care – across the whole Czech Republic on this theme.

It was shown that the recommended method was more effective with older doctors – almost 1/5 of general practitioners are in retirement age, there is a real risk of the loss of a sizeable portion of well versed professionals from primary care. The question how to address the young doctors is a burning issue in the whole Czech Medical Association.

Conclusion:

The formation and implementation of recommended method in the GPA, CMA JEP (Česká lékařská společnost Jana Evangelisty Purkyně) is a step in the right direction and is increasing the quality of primary care. There is the remaining problem of lesser activity of young doctors.