Are Physicians Influenced by Their Own Specialty Society's Guidelines Regarding Mammography Screening? An Analysis of Nationally Representative Data

Abstract

Family and internal medicine physicians, whose societies adhered to 2009 USPSTF recommendations for biennial screening starting at age 50 years, showed statistically significant decreases in mammography referral rates over time. Obstetricians and gynecologists, whose society continued to recommend annual screening starting at age 40 years, showed no statistically significant change in mammography referral rates over time. Physicians may be influenced by their own society's recommendations, which may influence their shared decision-making discussions with patients.

Factors Influencing Overuse of Breast Cancer Screening: A Systematic Review

“…[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Characteristics of included studies Among the included studies were three cohort studies, 17,27,28 five cross-sectional studies, 15,16,23,25,26 four surveys that measured physician's perceptions of the influence of guidelines on their practice or screening recommendations, [18][19][20]22 two surveys that measured patients' knowledge Table 1. Definitions of Overuse in Included Studies Any self-breast exam 24 Screening in patients with limited life expectancy 16,18,22,[24][25][26][27] Guideline discordant screening Offering nonrecommended MRI testing for screening 17,19,20 Utilizing multiple conflicting guidelines from USPSTF/ ACS/ACOG 22,25 Screening more frequently than recommended 16 Patient's lack of awareness and knowledge, or negative attitude toward, or resistance to implement the revised USPSTF guidelines 14,21,…”

“…Prominent flaws included the lack of reporting of response rates (in survey) 18 and the lack of use of validated tools for data collection. 19,21 One cross-sectional study 25 used office-based preventive service visits from the National Ambulatory Medical Care Survey (NAMCS) data, in which it was not possible to examine the frequency of screening by individual as some women patients could contribute multiple visits.…”

“…24 Clinician factors. Eight studies, including three crosssectional studies, 16,25,26 one cohort study, 27 and four surveys of physicians [18][19][20]22 evaluated clinician factors contributing to overuse of breast cancer screening. Seven of them, including four surveys of physicians, found an association of clinician factors with overuse of screening.…”

“…Seven of them, including four surveys of physicians, found an association of clinician factors with overuse of screening. 16,[18][19][20]22,25,27 Clinician sex was infrequently studied, but one multivariate model adjusting for patient and provider characters found that female health providers were more likely to overuse mammography than their male counterparts. 16 Physician specialty was evaluated as an influential contributor to overuse in three studies.…”

“…16 Physician specialty was evaluated as an influential contributor to overuse in three studies. 16,25,27 A cross-sectional study using data from National Ambulatory Medical Care Survey (NAMCS) found that, over time, family physicians and internists decreased use of mammography and obstetricians and gynecologists decreased use less so; these practices appeared to commensurate with their specialty societies' recommendations. Thus, judged according to the 2009 revised USPSTF guidelines, there was more overuse by obstetricians and gynecologists than by other clinicians.…”