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Physician and patient characteristics associated with outpatient breast cancer screening recommendations in the United States: analysis of the National Ambulatory Medical Care Survey Data 1996–2004

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background

The primary goal of breast cancer screening tests is to find cancer at an early stage before a person has any symptoms. Evidence suggests that screening examinations such as mammography and clinical breast examinations (CBE) are effective in early detection of breast cancer. Physician recommendation is an important reason many women undergo screening. This study examined the physician and patients related factors associated with physician recommendations for breast cancer screening in the United States (US) outpatient settings.

Methods

This cross-sectional study used data from the National Ambulatory Medical Care Survey (NAMCS) from 1996–2004. Women aged ≥40 years were included in the study sample. Multivariate logistic regression analyses were used to study the objectives.

Results

Weighted analysis indicated that physicians performed 198 million CBEs and made 110 million mammography recommendations over the study period (1996–2004). Patients’ age, duration of visits, history of previous breast cancer diagnosis, and source of insurance were significant predictors of screening recommendations in this population. Obstetricians and gynecologists were more likely to perform a CBE and recommend mammography than other specialty physicians.

Conclusions

These findings indicated that there were certain disparities regarding the physician recommendations of breast cancer screening for women in the US outpatient settings.

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References

  1. American cancer society: cancer facts and figures (2006) Atlanta, Ga: American Cancer Society, 2006. http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf

  2. Overview: Breast cancer. How many women get breast cancer? Available http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_How_many_people_get_breast_cancer_5.asp?sitearea=

  3. Ries L, Eisner M, Kosary C, et al (2002) SEER cancer statistics review, 1973–1999. National Cancer Institute Bethesda (MD)

    Google Scholar 

  4. Smith RA, Cokkinides V, Eyre HJ (2005) American cancer society guidelines for the early detection of cancer, 2005. CA Cancer J Clin 55:31–44

    PubMed  Google Scholar 

  5. Smith RA, Cokkinides V, Eyre HJ (2004) American cancer society guidelines for the early detection of cancer, 2004. CA Cancer J Clin 54:41–52

    PubMed  Google Scholar 

  6. Smith RA, Saslow D, Sawyer KA (2003) American cancer society guidelines for breast cancer screening: update 2003. CA Cancer J Clin 53:141–169

    Article  PubMed  Google Scholar 

  7. Tabar L, Fagerberg G, Chen HH, et al (1995) Efficacy of breast cancer screening by age: new results from the Swedish Two-County Trial. Cancer 75:2507–2517

    Article  PubMed  CAS  Google Scholar 

  8. Nystro¨m L, Rutqvist LE, Wall S, et al (1993) Breast cancer screening with mammography: overview of the Swedish randomized trials. Lancet 341:973–978

    Article  CAS  Google Scholar 

  9. Hendrick RE, Smith RA, Rutledge JH, et al (1997) Benefit of screening mammography in women ages 40–49: a new meta-analysis of randomized controlled trials. J Natl Cancer Inst Monogr 22:87–92

    PubMed  Google Scholar 

  10. Bjurstam N, Bjorneld L, Duy SW, et al (1997) The Gothenburg breast screening trial: first results on mortality, incidence, and mode of detection for women ages 39–49 years at randomization. Cancer 80:2091–2099

    Article  PubMed  CAS  Google Scholar 

  11. Andersson I, Janzon L (1997) Reduced breast cancer mortality in women under 50: updated results from the Malmo mammographic screening program. Monogr Natl Cancer Inst 22:63–68

    PubMed  Google Scholar 

  12. Shapiro S, Venet W, Strax P (1988) Periodic screening for breast cancer: the health insurance plan project and its sequelae, 1963–1986. Johns Hopkins University Press Baltimore

    Google Scholar 

  13. Alexander FE, Anderson TJ, Brown HK (1999) 14 years of follow-up from the Edinburgh randomised trial of breast screening. Lancet 355:1903–1908

    Article  Google Scholar 

  14. Smart CR, Hendrick RE, Rutledge JH, et al (1995) Benefit of mammography screening on women ages 40 to 49 years. Current evidence from randomized controlled trials. Cancer 75:1619–1626

    Article  PubMed  CAS  Google Scholar 

  15. Mandelblatt J, Saha S, Teutsch S, et al (2003) The cost-effectiveness of screening mammography beyond age 65 years: a systematic review for the US Preventive Services Task Force; Cost Work Group of the US Preventive Services Task Force. Ann Intern Med 139(10):I34

    Google Scholar 

  16. Burns RB, Freund KM, Ash AS, et al (1996) As mammography use increases, are some providers omitting clinical breast examination? Arch Intern Med 156:741–744

    Article  PubMed  CAS  Google Scholar 

  17. Barton MB (2005) Breast cancer screening. Benefits, risks, and current controversies. Postgrad Med 118:27–28

    Article  PubMed  Google Scholar 

  18. Barton MB, Harris R, Fletcher SW (1999) The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination should it be done? How? JAMA 282:1270–1280

    Article  PubMed  CAS  Google Scholar 

  19. Bobo JK, Lee NC, Thames SF (2000) Findings from 752,081 clinical breast examinations reported to a national screening program from 1995 through 1998. J Natl Cancer Inst 92(12):958–959

    Article  Google Scholar 

  20. Hawley ST, Earp JA, O’Malley M, et al (2000) The role of physician recommendation in women’s mammography use: is it a 2-stage process? Med Care 38:392–403

    Article  PubMed  CAS  Google Scholar 

  21. McGreevy KM, Baron LF, Hoel DG (2002) Clinical breast examination practices among women undergoing screening mammography. Radiology 224:555–559

    Article  PubMed  Google Scholar 

  22. O’Malley MS, Earp JA, Hawley ST, et al (2001) The association of race/ethnicity, socioeconomic status, and physician recommendation for mammography: who gets the message about breast cancer screening? Am J Public Health 9:49–54

    Google Scholar 

  23. Blustein J (1995) Medicare coverage, supplemental insurance, and the use of mammography by older women. N Engl J Med 332:1138–1143

    Article  PubMed  CAS  Google Scholar 

  24. Burns RB, McCarthy EP, Freund KM, et al (1996) Black women receive less mammography even with similar use of primary care. Ann Intern Med 125:173–182

    PubMed  CAS  Google Scholar 

  25. Burns RB, McCarthy EP, Freund KM, et al (1996) Variability in mammography use among older women. J Am Geriatr Soc 44:922–926

    PubMed  CAS  Google Scholar 

  26. Blackman DK, Bennett EM, Miller DS (1999) Trends in self-reported use of mammograms (1989–1997) and Papanicolaou tests (1991–1997)—behavioral risk factor surveillance system. MMWR CDC Surveill Summ 48:1–22

    Google Scholar 

  27. Ayanian JZ, Weissman JS, Schneider EC, et al (2000) Unmet health needs of uninsured adults in the United States. JAMA 284:2061–2069

    Article  PubMed  CAS  Google Scholar 

  28. Schapira MM, McAuliffe TL, Nattinger AB (2000) Underutilization of mammography in older breast cancer survivors. Med Care 38:281–289

    Article  PubMed  CAS  Google Scholar 

  29. Lash TL, Silliman RA (2001) Medical surveillance after breast cancer diagnosis. Med Care 39:945–955

    Article  PubMed  CAS  Google Scholar 

  30. Keating NL, Landrum MB, Guadagnoli E, et al (2006) Factors related to underuse of surveillance mammography among breast cancer survivors. J Clin Oncol 24(1):85–94

    Article  PubMed  Google Scholar 

  31. Eisenberg J (1979) Social influences on decision-making by clinicians. Ann Intern Med 90: 957–964

    PubMed  CAS  Google Scholar 

  32. Van Harrison R, Janz NK, Wolfe RA, et al (2003) Characteristics of primary care physicians and their practices associated with mammography rates for older women. Cancer 98(9):1811–1821

    Article  PubMed  Google Scholar 

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Author notes

  1. Rajesh Balkrishnan

    Present address: Department of Pharmacy Administration, Ohio State University College of Pharmacy, Columbus, OH, USA

Authors and Affiliations

  1. College of Pharmacy, Ohio State University, Columbus, OH, USA

    Monali Bhosle

  2. Division of Management, Policy, and community Health, University of Texas, School of Public Health, Houston, TX, USA

    Stephen Samuel

  3. School of Public Health, Division of Epidemiology, College of Medicine and Public Health, Ohio State University, Columbus, OH, USA

    Venkatanaras Vosuri

  4. School of Public Health, College of Medicine and Public Health, Ohio State University, Columbus, OH, USA

    Electra Paskett

Authors
  1. Monali Bhosle
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  2. Stephen Samuel
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  3. Venkatanaras Vosuri
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  4. Electra Paskett
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  5. Rajesh Balkrishnan
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Corresponding author

Correspondence to Rajesh Balkrishnan.

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Bhosle, M., Samuel, S., Vosuri, V. et al. Physician and patient characteristics associated with outpatient breast cancer screening recommendations in the United States: analysis of the National Ambulatory Medical Care Survey Data 1996–2004. Breast Cancer Res Treat 103, 53–59 (2007). https://doi.org/10.1007/s10549-006-9344-3

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  • DOI: https://doi.org/10.1007/s10549-006-9344-3

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