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APPENDIX B 143 EXAMPLE 3 GROUP HEALTH COOPERATIVE OF PUGET SOUND, INC. Screening for Breast Cancer The third guideline is taken from the Preventive Care Manual of the Group Health Cooperative of Puget Sound (GHCPS), a manual intended ''to help physicians and nurses. . .provide comprehensive preventive health care to [GHCPS] enrollees." The introduction to the manual describes how the Group Health Medical Staff Committee on Prevention evaluates screening tests and preventive interventions before they are recommended by the committee for general use in GHCPS. The manual was first compiled in 1987 as a draft document and is being revised on an ongoing basis. The major part of the manual consists of summaries of the committee's recommendations. The breast cancer screening statement presented below is one such summary. The manual is organized into separate sections on adult screening tests and interventions, pediatric screening tests and interventions, and immunizations. It also includes other information such as a bibliography and removable summary charts that allow quick reference for such information as well- adult screening schedules and general immunization guidelines.
APPENDIX B 144
APPENDIX B 145 Subject: Adult Screen July, 1990 - Committee on BREAST CANCER Update Prevention Reviewed - 1983, 1988 FOLLOW UP: Women with abnormalities detected through the GHC breast cancer screening program will be followed through the program. The primary care physician will be kept informed. Other patients with abnormal findings on BSE or PE should be managed by their primary MD including referral for surgical evaluation when indicated. COMMENTS: Under the provisions of the GHC risk protocol, 83 percent of all women and 100 percent of all women above age 49, will have mammography at some interval. The percent of women in each screening interval group and their estimated relative risks of developing breast cancer are shown in the table below. The risk algorithm and cancer outcomes from the program are being scientifically evaluated. At present it remains the physicians' prerogative to order a screening mammogram outside the Breast Cancer Screening Program. Women with a history of breast cancer should get annual mammography through their primary care physician. Mammography Percent of Estimated Interval Women Relative Risk One Year 3% 4-14 Two Years 17% 1.9-3.5 Three Years 63% 1.2-1.9 Not Recommended 17% 1.0 References: 1. Carter AP, Thompson RS, Bourdeau RV: A clinically effective Breast Cancer Screening Program can be cost-effective too. Prev Med, 1987;16:29-34. 2. Taplin SH, Anderman C: Risk-based breast cancer screening in an HMO: The first year's experience. Group Health Institute Proceedings, June 1987. 3. Thompson RS, Taplin SH, Carter AP, Schnitzer F, Anderman C, Anderson, E, White E, Wagner EH: A risk-based breast cancer screening program. HMO Practice 1988;2:177-191. 4. Taplin SH, Anderman C, Grothaus L: Breast cancer risk and participation in mammographic screening. Am J Pub Health, 1989;79:1494-1498. 5. Thompson RS, Taplin S, Carter AP, Schnitzer F: Cost effectiveness in program delivery. Cancer, Dec.15,1989;Supplement:2682-2689. 6. Taplin S, Thompson RS, Schnitzer F, Anderman CA, Immanuel V: Revisions in the Risk-Based Breast Cancer Screening Program at Group Health Cooperative, (Cancer, in press for August, 1990).