Received from the Division of General Medicine (JH), Brigham and Women's Hospital, Boston, Mass; and Medical Effectiveness Research Center, Division of General Internal Medicine, Department of Medicine (CPK, SEG, EJP-S, GDJ), University of California, San Francisco, Calif.
Do Physicians Tailor Their Recommendations for Breast Cancer Risk Reduction Based on Patient's Risk?
Article first published online: 2 APR 2004
Journal of General Internal Medicine
Volume 19, Issue 4, pages 302–309, April 2004
How to Cite
Haas, J. S., Kaplan, C. P., Gregorich, S. E., Pérez-Stable, E. J. and Des Jarlais, G. (2004), Do Physicians Tailor Their Recommendations for Breast Cancer Risk Reduction Based on Patient's Risk?. Journal of General Internal Medicine, 19: 302–309. doi: 10.1111/j.1525-1497.2004.30280.x
- Issue published online: 2 APR 2004
- Article first published online: 2 APR 2004
- breast cancer;
- risk reduction;
- physician survey
OBJECTIVE: To investigate how physicians tailor their recommendations for breast cancer prevention and risk reduction.
DESIGN: Cross-sectional, mail survey.
PARTICIPANTS: Random sample of primary care physicians in California (N = 822).
MEASUREMENTS AND MAIN RESULTS: Six standardized patient scenarios were used to assess how women's breast cancer risk factors influence physicians’ recommendations for screening mammography, counseling about lifestyle behaviors, genetic testing, the use of tamoxifen, prophylactic surgery, and referral to a breast specialist. Over 90% of physicians endorsed mammography for all of the scenarios. Similarly, approximately 80% of physicians endorsed counseling about lifestyle factors for all of the scenarios. Five-year risk of developing breast cancer and family history were both strongly associated with each of the 6 recommendations. Importantly, however, physicians were more likely to endorse the discussion of genetic testing, the use of tamoxifen, and prophylactic surgery for women with a family history of breast cancer compared with women at a higher risk of developing breast cancer but without a family history. Obstetrician-gynecologists were more likely to endorse most of these practices compared with internists.
CONCLUSIONS: Mammography and counseling about lifestyle behaviors are widely endorsed by physicians for breast cancer prevention and risk reduction. Whereas physicians are generally able to tailor their recommendations for prevention and risk reduction based on risk, they may perhaps underutilize genetic evaluation and newer therapeutic options for primary prevention for women who are at high risk of developing breast cancer but do not have a family history.