Women???s Primary Care Providers and Breast Cancer Screening: Who???s Following the Guidelines?

Abstract

The practice of prescribing mammography annually or biannually for women 50 to 69 years of age is widely accepted, because it has markedly reduced deaths from breast cancer. The goal of this study was to determine whether the type of provider (family or general practitioner, internist, gynecologist) or the provider's training degree (doctor of medicine or osteopathy, nurse practitioner, physician assistant) influences compliance with current screening guidelines. The retrospective cohort study included 472 women in this age group from the 2000 National Ambulatory Medical Care Survey who made a total of 16 million preventive healthcare visits. Approximately two thirds of breast examinations and mammograms were associated with preventive health visits. A majority, 55%, of preventive health visits included breast examination, and 32% recommended mammography. Internists and family practitioners were much less likely to do a breast examination than gynecologists, who did so at 87% of preventive care visits. The figure was 33% for internists (relative risk [RR], 0.37) and 45% for family practitioners (RR, 0.52). Gynecologists prescribed mammography at 87% of preventive care visits compared with 30% of internists (RR, 0.38) and 22% of family practitioners (RR, 0.43). Medical doctors accounted for approximately 88% of preventive health visits for women 50 to 69 years of age. Doctors of osteopathy and midlevel practitioners each provided 6% of visits. For all primary care specialties, midlevel providers were much more likely than either medical doctors or doctors of osteopathy to do a breast examination and also were more likely to prescribe mammography. Nearly three fourths (74%) of midlevel providers identified themselves as primary care providers, as did 61% of internists and 72% of osteopaths. It seems likely that specialty-directed provider interventions would improve adherence to guidelines for breast examination and mammography. All practitioners who provide preventive care should be encouraged to comply with medical guidelines for breast cancer screening.