Breast Cancer Risk Assessment and Chemoprevention Use Among Veterans Affairs Primary Care Providers: A National Online Survey

Abstract

Introduction Breast cancer is the most common cancer diagnosed among women and the second most common cause of cancer death among women. There are ways to reduce a woman’s risk of breast cancer; however, most eligible women in the United States are neither offered personalized screening nor chemoprevention. Surveys have found that primary care providers are largely unaware of breast cancer risk assessment models or chemoprevention. This survey aims to investigate Veterans Health Administration primary care providers’ comfort level, practice patterns, and knowledge of breast cancer risk assessment and chemoprevention. Materials and Methods An online, Research Electronic Data Capture-generated survey was distributed to VHA providers in internal medicine, family medicine, and obstetrics/gynecology. Survey domains were provider demographics, women’s health experience, comfort level, practice patterns, barriers to using risk models and chemoprevention, and knowledge of chemoprevention. Results Of the 167 respondents, 33.1% used the Gail model monthly or more often and only 2.4% prescribed chemoprevention in the past 2 years. Most VHA primary care providers did not answer chemoprevention knowledge questions correctly. Designated women’s health providers were more comfortable with risk assessment (P < 0.018) and chemoprevention (P < 0.011) and used both breast cancer risk models (P < 0.0045) and chemoprevention more often (P < 0.153). Reported barriers to chemoprevention were lack of education and provider time. Conclusions VHA providers and women Veterans would benefit from a system to ensure that women at increased risk of breast cancer are identified with risk modeling and that risk reduction options, such as chemoprevention, are offered when appropriate. VHA providers requested risk reduction education, which could improve primary care provider comfort level with chemoprevention.

Breast Cancer Risk Assessment and Primary Prevention Advice in Primary Care: A Systematic Review of Provider Attitudes and Routine Behaviours

“…Providers specialising in women's health reported feeling more comfortable using a breast cancer risk assessment tool and prescribing risk-reducing medication [46]. These providers were also less likely to agree that the risks of prescribing risk-reducing medications outweighed the benefits in comparison to other primary care providers [45].…”

Perceptions of Racially and Ethnically Diverse Women at High Risk of Breast Cancer Regarding the Use of a Web-Based Decision Aid for Chemoprevention: Qualitative Study Nested Within a Randomized Controlled Trial

“…This web-based DA incorporates 2 complementary theoretical frameworks-shared decision making [23] and self-determination theory (SDT) [24]-to engage women in planning a preference-sensitive course of decision making about chemoprevention. SDT has at its core the concept of autonomous motivation [24][25][26] and describes autonomous choices as those that a person could fully endorse upon reflection [27][28][29]. This is contrasted with behaviors or choices that feel controlled or coerced by another person.…”

Understanding low chemoprevention uptake by women at high risk of breast cancer: findings from a qualitative inductive study of women’s risk-reduction experiences

“…The majority of healthcare providers-from generalists to breast surgeons-lack comfort and experience in identifying high-risk women using Gail or other risk assessment models [22,[52][53][54]. Both general practitioners and familial cancer specialists also lack core knowledge about chemoprevention and experience prescribing it [23,55,56]. The most common barriers physicians identify in their own ability to advise patients about chemoprevention are lack of education on the topic and lack of time to discuss it [49,54,55]; many also remain unconvinced that chemoprevention can be effective [22,57] or unaware that it is clinically recommended for some groups of patients [23].…”

“…Both general practitioners and familial cancer specialists also lack core knowledge about chemoprevention and experience prescribing it [23,55,56]. The most common barriers physicians identify in their own ability to advise patients about chemoprevention are lack of education on the topic and lack of time to discuss it [49,54,55]; many also remain unconvinced that chemoprevention can be effective [22,57] or unaware that it is clinically recommended for some groups of patients [23]. Our findingsand the additional context provided by these studies of clinician-level barriers-suggest structural interventions that could assist high-risk women in becoming fully informed about their risk-reduction options.…”