Despite the oft-repeated recommendation that patients should be involved in all significant medical decisions, many physicians leave patients out of the loop when deciding whether to order tests for early detection of breast and prostate cancers, according to a study published in the American Journal of Preventive Medicine (2001;20:130-134). 

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Figure  . Talking with patients about cancer screening tests

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Flawed Communication

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These study results are startling, disturbing, and very useful, according to Hugh Stallworth, MD, MPH, national vice president of cancer risks and sites at the American Cancer Society (ACS).

Researchers at Mt. Sinai Medical Center in New York City believe the study illustrates a broad problem: Flawed communication between many practitioners and patients.

In the study, 169 primary care physicians in urban New York hospitals were asked whether they would order a mammogram for a healthy 45-year-old woman and a healthy 55-year-old woman, and whether they would order a prostate specific antigen (PSA) test for a healthy 55-year-old man. They were also asked whether they would discuss the pros and cons of the tests with these patients.

Nearly all the physicians would order the mammogram for the 55-year-old woman, but about one-fourth would not order the test for the 45-year-old woman, according to the study. One-fifth of the physicians said they would not discuss the test with the 45-year-old woman. Yet, the ACS and the National Cancer Institute recommend that women start having annual mammograms at age 40.

Only about one-fourth of the respondents said they would order the PSA test for the 55-year-old man, and one-third said they would not discuss the test with the patient. The ACS recommends that beginning at age 50, serum PSA measurement and digital rectal exams should be offered annually to men who have a life expectancy of at least 10 years.

Men at high risk (such as blacks and men with a first-degree relative diagnosed with prostate cancer at a young age) should begin testing at age 45. Patients should be given information about the benefits and limitations of testing so they can make informed decisions, according to ACS guidelines.

Lead author Andrew Dunn, MD, an assistant professor of medicine at Mt. Sinai School of Medicine, emphasizes that the majority of physicians who participated in the study reported discussing the PSA test with their patients. “But a third don't. We think that's a substantial number of doctors.”

Physicians said that lack of time, the complexity of the topics, and a language barrier with some patients influenced their tendency to decide about the cancer screening tests without patient participation. Dunn hopes the study will help the medical community understand the importance of faithfully holding such conversations.