Breast cancer screening beliefs, recommendations and practices

Abstract

Primary care physicians (PCPs) play a key role in breast cancer screening, yet no current data exist regarding PCP practices. The authors analyzed a nationally representative survey of PCPs that was fielded during September 2006 to May 2007 to investigate PCP breast cancer screening beliefs, recommendations, and practices. Most of the 1212 PCPs who participated in the survey (80%) reported that mammography for average-risk women aged ≥ 50 years was very effective in reducing cancer mortality, and 54% reported that it was very effective for women ages 40 to 49 years. Fewer respondents reported that clinical breast examination (CBE) or breast self-examination (BSE) was very effective, but the majority rated CBE and BSE as somewhat effective. The majority of PCPs routinely recommended mammography, CBE, and BSE to patients aged ≥ 40 years. In multivariate models, family/general practitioners (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.57-3.17 for mammography; OR, 4.42; 95% CI, 2.60-7.52 for CBE) and internal medicine specialists (OR, 3.21; 95% CI, 2.21-4.66 for mammography; OR, 5.34; 95% CI, 3.21-8.88 for CBE) were more likely to recommend an upper age limit for screening than obstetrician/gynecologists. Physicians who reported that US Preventive Services Task Force guidelines were very influential were more likely to recommend an age at which they no longer recommend mammography and CBE. To the authors' knowledge, the current study is the first national study in over 2 decades to report the breast cancer screening practices of PCPs and provides baseline data for monitoring the impact of changes in clinical practice guidelines. The current findings suggested that virtually all PCPs routinely recommend mammography, CBE, and BSE to their patients aged ≥ 40 years, although recommendations vary by primary care specialty.