U.S. primary care physicians' breast cancer screening beliefs and practices

For close to two decades, scientific experts have disagreed about the age at when to start and stop breast cancer screening, the schedule on which tests should occur and the effectiveness of different screening modalities. Despite these controversies, most experts agree that screening has been effective in reducing breast cancer mortality.

While much is known about factors influencing women to get screened, little information is available about physicians' current breast cancer screening practices. This study explores the characteristics of four types of primary care physicians (family practice, general medicine, internal medicine and obstetrics/gynecology) and how their beliefs and practices are associated with breast cancer screening using the National Survey of Primary Care Physicians' Recommendations and Practice for Breast, Cervical, Colorectal and Lung Cancer Screening. The survey, fielded September 2006-May 2007, included questions about physician and practice characteristics and recommendations for breast cancer screening for women ages 40-49 and 50 and older. Physicians also were queried about their beliefs regarding clinical guidelines, test effectiveness and barriers to screening.

In our sample of primary care physicians (N=1212), virtually all report routinely recommending mammography, clinical breast exam and breast self exam to their patients. For those who recommend tests, there was variation in factors associated with recommending an age at which to discontinue screening. These include physician specialty, gender, international medical training and perceptions of which breast cancer screening guidelines are influential.

These results serve as an important baseline to monitor the impact of changes in age-specific clinical guidelines on physician screening practices.