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In response to a recent study indicating that primary care physicians were interested in receiving breast-screening education, an office-based training program was developed and delivered to fourteen physicians in Vermont and Florida. A nonphysician trainer and simulated patient provided instruction and feedback in clinical breast examination and in patient instruction in breast self-examination. Measurements of physician palpation skills before and after the training showed substantial skill improvement, and the office-based session was found to be highly acceptable by all participants.

Methodologic issues in modeling breast cancer deaths were investigated through modeling the number of breast cancer deaths in Vermont for the period 1975 to 1988. Age-specific incidence rates, case fatality rates, and secular trends of these rates were necessary to represent the observed trend in breast cancer deaths over this time period. Additional information, such as mortality from other causes, stage distribution, or screening history, was not necessary. Incidence and survival information were obtained from a statewide population-based breast cancer registry in Vermont and the Surveillance, Epidemiology and End Results (SEER) program. SEER incidence rates overestimated the actual number of deaths for long-term survival rates. Case fatality rates and secular trends in incidence and survival reported by SEER were appropriate. These results can be applied to the planning of community intervention studies by providing the essential expected numbers of deaths in control communities.

To assess the morbidity and mortality of thyroid operations, Professional Activity Study records of the Commission on Professional and Hospital Activities, representing an estimated one-third of all thyroidectomies performed in the United States in 1970, were reviewed. The mortality after a thyroid operation for nontoxic goiter was 0.02 per cent for patients less than the age of 50 years but increased with age to 0.66 per cent for those 70 years and older. No in-hospital deaths followed thyroidectomy for malignant goiter in 766 patients less than 40 years of age. Thyroidectomy for diffuse toxic goiter had a mortality fivefold greater than did operations for a benign nontoxic goiter. Total thyroidectomy was used for the treatment of nontoxic, nonmalignant goiter for one in 12 patients and resulted in greater morbidity than did partial or subtotal thyroidectomy. Rational choice of operation for the treatment of goiter for individual patients should be based upon knowledge of the specific risks of surgical treatment, which vary greatly depending upon the age of the patient, whether or not the goiter is toxic or nontoxic and whether or not subtotal or total thyroidectomy is performed.

To quantitate the relationship between breast self-examination and survival from breast cancer, we have studied 1,003 newly diagnosed patients with invasive breast cancer in Vermont general hospitals since July 1, 1975. Death certificates, autopsy reports, and hospital records were reviewed to determine the cause of death. Examination of product limit survival curves by three age groups demonstrated that death due to breast cancer was less likely in breast cancer patients who had performed breast self-examination than in nonperformers in each of the three age groups. The associated lead-time would have to exceed 36 months to negate the apparent beneficial effects of breast self-examination in decreasing the likelihood of death from breast cancer. We conclude that in this population of breast cancer patients, breast self-examination probably contributed to earlier detection and thereby improved survival.

To determine the relation between breast self-examination and survival of breast cancer patients, the authors studied 1004 newly diagnosed invasive breast cancer patients in Vermont general hospitals from 1 July 1975 to 31 December 1982. More frequent breast self-examination was associated with a greater likelihood of the patient's detecting her own cancer, less delay from first symptom to histologic diagnosis, earlier clinical stage, smaller pathologic tumor size, and fewer axillary node metastases. At a median follow-up time of 52 months (maximum follow-up, 92 months), 14% of the breast self-examination performers had died of breast cancer versus 26% of the nonperformers (P less than 0.001 based on chi-square). The product limit survival curve for breast self-examination performers (N = 424) was significantly better (P less than 0.001 by log-rank test) than for breast self-examination nonperformers (N = 411). Survival at 5 years was 75% for breast self-examination performers versus 57% for the nonperformers. The significant survival differences persisted after adjusting for any combination of the covariates age, method of detection, family history of breast cancer, and delay in treatment (P less than 0.002). Lead-time would have to be at least 3 years to negate the apparent beneficial effects of breast self-examination on survival. The authors conclude that in this population of breast cancer patients, breast self-examination was related to earlier detection and improved survival.