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Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey



Professional organizations have issued guidelines recommending breast cancer screening for women 50 years of age.


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.


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.


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.


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.


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.


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.

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Contributors: We thank Barbara Matthews, MBA (University of Washington [UW]) and Denise Lishner, MSW (UW) for their administrative help; Barbara Mathews, MBA (UW) for providing the database; Blythe Ryerson, MPH (CDC) for her early contributions to the development of the Women’s Health Survey study’s methods; and Donna Berry, RN PhD (Dana Farber Cancer Institute), Barbara Matthews, MBA (UW), Denise Lishner, MSW (UW), Katrina F. Trivers, PhD (CDC), and Jacqueline W. Miller, MD (CDC) for their contributions to the development of the Women’s Health Survey. Gilmore Research Group in Seattle, Washington conducted the survey.

Funders: This project was funded by the Centers for Disease Control and Prevention (CDC) through the University of Washington Health Promotion Research Centers Cooperative Agreement U48DP001911, and through the Alliance for Reducing Cancer, Northwest (ARC NW), funded by the Centers for Disease Control and Prevention (CDC; Grant U48DP001911, V. Taylor, PI), the National Cancer Institute (NCI), and the University of Washington Primary Care Research (NRSA) Fellowship, funded by HRSA. The findings and conclusions of this journal article are those of the authors and do not represent the official position of the Centers for Disease Control and Prevention, the National Cancer Institute, or the University of Washington.

Prior presentations: Kadivar H, Goff B, Phillips W, Berg A, Andrilla H, Baldwin LM. U.S. Preventive Services Task Force-Inconsistent Screening for Breast and Colorectal Cancer. Poster presentation, Academy Health Annual Research, Seattle, Washington. June 13, 2011.

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All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported no conflicts related to this work.

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Correspondence to Hajar Kadivar MD, MPH.

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Kadivar, H., Goff, B.A., Phillips, W.R. et al. Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey. J GEN INTERN MED 29, 82–89 (2014).

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  • breast cancer
  • cancer screening
  • guidelines
  • physician behavior
  • primary care
  • prevention
  • malpractice
  • risk assessment