Overuse of mammography among primary care physicians: Factors associated with recommending mammography to older women with a terminal comorbidity

There is debate about which women should be screened for breast cancer, especially those at advanced age, with poor health status, or with perceived limited life expectancy. Breast cancer screening guidelines currently range from conservative (US Preventive Services Task Force) to liberal (American College of Obstetricians and Gynecologists, ACOG) regarding whether and when to stop screening. These divergent views can result in confusion and potentially to overuse of mammography by physicians, or recommending mammography to women who would receive little to no benefit from screening. Currently, little is known about characteristics of physicians who may over-recommend mammography. This study analyzed data from a large, nationally-representative survey of primary care physicians (PCPs; N=1195) to examine breast cancer screening recommendations for hypothetical patients age 65 and 80 with stage 4 unresectable lung cancer, a terminal comorbidity. Many PCPs reported that they would recommend mammography to a 65 or 80 year old woman with terminal lung cancer (40.84%). Physician characteristics associated with recommending mammography for terminally ill older women included being an OB/GYN (compared to a family/general [OR=0.61] or internal medicine physician [OR=0.32]), being “very influenced” by ACOG guidelines [OR=1.51], and being a racial/ethnic minority (OR=1.47). These results suggest an overuse of mammography among terminally ill older women, and raise questions about whether more liberal guidelines are contributing to physicians' mammography recommendations for women who are likely to receive little benefit from screening.