Although the American College of Radiology, the National Cancer Institute, and the American Cancer Society recommend screening mammography for women more than 40 years old, there is little compliance with these recommendations. Primary-care physicians are often reluctant to refer patients for the procedure, whereas the patients are usually willing to undergo the procedure. This survey documents the underuse of screening mammography by family physicians who are members of the Michigan Academy of Family Physicians. The underuse of mammography by this physician sample was due to two main factors: The physicians perceived far more disadvantages than advantages with mammography and perceived problems (with, e.g., equipment, effectiveness, and patient acceptance) as pervasive. To change the attitudes and referral behavior of family physicians, one must take into account the specific, negative perceptions of the procedure and place an emphasis on the initial referral, since subsequent referrals are easier to implement.

The early detection of breast cancer is promoted by the American Cancer Society (ACS) and the American College of Radiology (ACR) by encouraging the regular use of three types of screening: breast self-examination (BSE), the clinical breast examination, and mammography. In August 1983, the ACS publicized seven recommendations pertaining to screening, including a revised statement about the routine use of mammography for women between the ages of 40 and 49 years. In response to the ACS statement, the present study assessed compliance with the updated recommendations for all three types of screening. The results show reasonable rates of compliance for the BSE (53%-69%) and clinical examination (70%-78%). In contrast, only 19% of the women between the ages of 35 and 49 and 25% of the women older than 50 reported complying with the recommendation to undergo one baseline screening mammogram. In addition, only 9% of the mammograms were obtained for the early detection of disease, which is the rationale for the recommendation. In fact, it appears that mammography is being performed mainly for the diagnosis of symptomatic women instead of the screening of asymptomatic women. Some implications for health education by physicians and the professional education by physicians and the professional education of physicians in the use of mammography are discussed.

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