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.
Article info
Publication history
Accepted:
March 7,
2014
Received in revised form:
March 6,
2014
Received:
October 23,
2013
Footnotes
There are no disclosures or conflicts of interest for any study authors. The Thomas H. Nimick Jr. Competitive Research Fund provided money for the purchase of iPads that were given as incentives to two randomly selected study participants. The Division of General Internal Medicine at UPMC provided funding for data management. Dr. Corbelli's fellowship in women's health was funded by the VA. These sources had no role in the study design or implementation of results, or manuscript preparation.
Identification
Copyright
© 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
