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Original Article
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Physician over-recommendation of mammography for terminally ill women†‡
Article first published online: 16 JUN 2011
DOI: 10.1002/cncr.26233
Copyright © 2011 American Cancer Society
Additional Information
How to Cite
Leach, C. R., Klabunde, C. N., Alfano, C. M., Smith, J. L. and Rowland, J. H. (2012), Physician over-recommendation of mammography for terminally ill women. Cancer, 118: 27–37. doi: 10.1002/cncr.26233
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We thank Gigi Yuan of IMS (Rockville, MD) for statistical support.
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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.
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Publication History
- Issue published online: 16 DEC 2011
- Article first published online: 16 JUN 2011
- Manuscript Accepted: 8 APR 2011
- Manuscript Revised: 16 MAR 2011
- Manuscript Received: 6 JAN 2011
- Abstract
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Keywords:
- breast cancer;
- mammography;
- primary care;
- practice guidelines;
- screening
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.