Physician over-recommendation of mammography for terminally ill women

Authors

  • Corinne R. Leach PhD, MPH,

    Corresponding author
    1. Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda Maryland
    2. Behavioral Research Center, American Cancer Society, Atlanta, Georgia
    • Behavioral Research Center, American Cancer Society, 250 Williams St., Atlanta, GA 30303

    Search for more papers by this author
    • Fax: (404) 929-6832

  • Carrie N. Klabunde PhD,

    1. Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda Maryland
    Search for more papers by this author
  • Catherine M. Alfano PhD,

    1. Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda Maryland
    Search for more papers by this author
  • Judith Lee Smith PhD,

    1. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta Georgia
    Search for more papers by this author
  • Julia H. Rowland PhD

    1. Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda Maryland
    Search for more papers by this author

  • We thank Gigi Yuan of IMS (Rockville, MD) for statistical support.

  • The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Cancer Institute, the American Cancer Society, or the Centers for Disease Control and Prevention.

Abstract

BACKGROUND:

There has been recent, sometimes intense, debate about when to begin screening and how often to screen women for breast cancer with mammography. However, there should be no controversy regarding screening women who are unlikely to benefit from the procedure, such as those with a serious, life-limiting illness who would not live long enough to benefit from the potential detection and treatment of breast cancer. Identifying characteristics of physicians who recommend mammography for terminally ill women can help guide efforts to minimize patient risks and make better use of health care resources.

METHODS:

The authors used data from a nationally representative survey of primary care physicians (PCPs) (N = 1196; response rate, 67.5%) conducted in 2006 and 2007 to examine PCPs' breast cancer screening recommendations for hypothetical patients ages 50 years, 65 years, and 80 years who were healthy, had a moderate comorbidity, or had a terminal comorbidity.

RESULTS:

Many PCPs (47.7%) reported that they would recommend mammography to a woman aged 50 years, 65 years, or 80 years with terminal lung cancer, indicating over-recommendation. Physician characteristics associated with over-recommending mammography included obstetrician/gynecologist (odds ratio [OR], 1.69) or internal medicine (OR, 0.45) specialty, being a woman (OR, 1.40), being a racial/ethnic minority (OR, 1.72), and working in a smaller practice (OR, 1.41).

CONCLUSIONS:

The current results indicated that physician over-recommendation of screening mammography among terminally ill women is common. Certain physician and practice characteristics, including specialty, were associated with over-recommending mammography. The authors concluded that an informed and shared mammography decision-making process for terminally ill women may eliminate unnecessary patient risks and health care expenditures. Cancer 2012;. © 2011 American Cancer Society.

Ancillary