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Physician Adherence to U.S. Preventive Services Task Force Mammography Guidelines

      Abstract

      Background

      In 2009, the U.S. Preventive Services Task Force (USPSTF) guidelines for screening mammography changed significantly, and are now in direct conflict with screening guidelines of other major national organizations. The extent to which physicians in different primary care specialties adhere to current USPSTF guidelines is unknown.

      Methods

      We conducted a cross-sectional web-based survey completed by 316 physicians in internal medicine, family medicine (FM), and gynecology (GYN) from February to April 2012. Survey items assessed respondents' breast cancer screening recommendations in women of different ages at average risk for breast cancer. We used descriptive statistics to generate response distribution for survey items, and logistic regression models to compare responses among specialties.

      Findings

      The response rate was 55.0% (316/575). A majority of providers in internal medicine (65%), FM (64%), and GYN (92%) recommended breast cancer screening starting at age 40 versus 50. A majority of providers in internal medicine (77%), FM (74%), and GYN (98%) recommended annual versus biennial screening. Gynecologists were significantly more likely than both internists and family physicians to recommend initial mammography at age 40 (p ≤ .0001) and yearly mammography (p = .0003). There were no other differences by respondent demographic.

      Conclusions

      Primary care providers, especially gynecologists, have not implemented USPSTF guidelines. The extent to which these findings may be driven by patient versus provider preferences should be explored. These findings suggest that patients are likely to receive conflicting breast cancer screening recommendations from different providers.
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      Biography

      Jennifer Corbelli, MD, MS, is an Assistant Professor of Medicine at the University of Pittsburgh. Her research interests include breast cancer screening and prevention in primary care, as well as resident education in both curricular and clinical settings.

      Biography

      Sonya Borrero, MD, MS, is an Assistant Professor of Medicine at the University of Pittsburgh and Core Faculty at the Center for Research on Health Care and Promotion (CHERP) at the VA Pittsburgh Healthcare System. Her research interests include women's reproductive health and disparities.

      Biography

      Rachel Bonnema, MD, MS, is an Assistant Professor of Medicine at the University of Nebraska, and an Associate Program Director for the internal medicine training program. Her research interests include women's health, including management of medical comorbidities in pregnancy, and medical education.

      Biography

      Megan McNamara, MD, MS, is an Assistant Professor of Medicine at Case Western Reserve University, and Director of the Center for Advancement of Medical Learning. Her research interests include women's health, mentorship, and curricular development in evidence-based medicine.

      Biography

      Kevin Kraemer, MD, MS, is a Professor of Medicine and Clinical and Translational Science at the University of Pittsburgh, and the director of both the RAND University of Pittsburgh Scholars program and the University of Pittsburgh General Internal Medicine Fellowship. His research interests include alcohol and substance abuse.

      Biography

      Doris Rubio, PhD, is a Professor of Medicine, Biostatistics, Nursing and Clinical and Translational Science at the University of Pittsburgh. She is the director of the Data Center for the Center for Research on Health Care, and co-director for the Institute for Clinical Research Education.

      Biography

      Irina Karpov, MS, is a data analyst at the University of Pittsburgh's Center for Research on Health Care. Her areas of expertise include data analysis for medical investigators, primarily using SAS software.

      Biography

      Melissa McNeil, MD, MPH, is the Associate Chief of the Division of General Internal Medicine at the University of Pittsburgh, Chief of the Section of Women's Health, and Director of the Women's Health Fellowship. Her areas of expertise include women's health and medical education at all levels.