PMID- 23943421
OWN - NLM
STAT- MEDLINE
DCOM- 20140911
LR  - 20211021
IS  - 1525-1497 (Electronic)
IS  - 0884-8734 (Print)
IS  - 0884-8734 (Linking)
VI  - 29
IP  - 1
DP  - 2014 Jan
TI  - Guideline-inconsistent breast cancer screening for women over 50: a 
      vignette-based survey.
PG  - 82-9
LID - 10.1007/s11606-013-2567-1 [doi]
AB  - BACKGROUND: Professional organizations have issued guidelines recommending breast 
      cancer screening for women 50 years of age. OBJECTIVE: This study examines the 
      percent of U.S. primary care physicians who report breast cancer screening 
      practices that are not consistent with guidelines, and the characteristics of 
      physicians who reported offering extra test modalities. DESIGN: We analyzed a 
      subset of a 2008 cross-sectional Women's Health Care survey sent to primary care 
      physicians randomly selected from the national American Medical Association (AMA) 
      Physician Masterfile. A subset of physicians received a survey that presented a 
      vignette of a health maintenance visit for an asymptomatic 51-year-old woman who 
      was not at high risk for breast cancer. Responses were weighted to represent 
      physicians nationally. PARTICIPANTS: 1,654 U.S. family physicians, general 
      internists, and obstetrician-gynecologists under age 65, who practiced in office 
      or hospital based settings (62.8 % response rate). After exclusions, 553 study 
      physicians remained for analysis. MAIN MEASURE: Physician self-report of breast 
      cancer screening practices that are not consistent with the recommendations of 
      the U.S. Preventive Services Task Force (USPSTF), the American College of 
      Obstetrics and Gynecology (ACOG), and the American Cancer Society (ACS), defined 
      as almost always offering mammography. KEY RESULTS: 36.0 % (95 % CI: 31.8 %-40.5 
      %) of physicians reported offering breast cancer screening tests inconsistent 
      with national guidelines, with most offering extra tests (magnetic resonance 
      imaging [MRI] and/or ultrasound) (33.2 %, 95 % CI 29.1 %-37.6 %). In adjusted 
      analysis, risk-averse physicians and those who believed in the clinical 
      effectiveness of MRI were more likely to offer extra breast cancer screening 
      tests. CONCLUSIONS: Physicians often report offering breast cancer screening test 
      modalities beyond those recommended for a 51-year-old woman. Strategies, such as 
      academic detailing regarding appropriate use of technology and provision of 
      clinical decision support for breast cancer screening, could decrease overuse of 
      resources.
FAU - Kadivar, Hajar
AU  - Kadivar H
AD  - University of Florida College of Medicine, PO Box 100177, Gainesville, FL, 
      32610-0177, USA, kadivar@ufl.edu.
FAU - Goff, Barbara A
AU  - Goff BA
FAU - Phillips, William R
AU  - Phillips WR
FAU - Andrilla, C Holly A
AU  - Andrilla CH
FAU - Berg, Alfred O
AU  - Berg AO
FAU - Baldwin, Laura-Mae
AU  - Baldwin LM
LA  - eng
GR  - U48 DP001911/DP/NCCDPHP CDC HHS/United States
GR  - U48DP001911/DP/NCCDPHP CDC HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20130814
PL  - United States
TA  - J Gen Intern Med
JT  - Journal of general internal medicine
JID - 8605834
SB  - IM
MH  - Breast Neoplasms/*diagnosis
MH  - Cross-Sectional Studies
MH  - Early Detection of Cancer/methods/*standards
MH  - Female
MH  - Guideline Adherence/statistics & numerical data
MH  - Health Care Surveys
MH  - Health Services Research/methods
MH  - Humans
MH  - Magnetic Resonance Imaging/statistics & numerical data
MH  - Male
MH  - Mammography/standards/statistics & numerical data
MH  - Middle Aged
MH  - Physicians, Primary Care/psychology/standards/statistics & numerical data
MH  - *Practice Guidelines as Topic
MH  - Professional Practice/statistics & numerical data
MH  - Risk Assessment/methods
MH  - Risk-Taking
MH  - Ultrasonography, Mammary/statistics & numerical data
MH  - United States
MH  - Unnecessary Procedures/statistics & numerical data
PMC - PMC3889955
EDAT- 2013/08/15 06:00
MHDA- 2014/09/12 06:00
PMCR- 2015/01/01
CRDT- 2013/08/15 06:00
PHST- 2013/03/26 00:00 [received]
PHST- 2013/06/27 00:00 [accepted]
PHST- 2013/06/18 00:00 [revised]
PHST- 2013/08/15 06:00 [entrez]
PHST- 2013/08/15 06:00 [pubmed]
PHST- 2014/09/12 06:00 [medline]
PHST- 2015/01/01 00:00 [pmc-release]
AID - 2567 [pii]
AID - 10.1007/s11606-013-2567-1 [doi]
PST - ppublish
SO  - J Gen Intern Med. 2014 Jan;29(1):82-9. doi: 10.1007/s11606-013-2567-1. Epub 2013 
      Aug 14.