1
|
Panach-Navarrete J, Gironés-Montagud A, Sánchez-Cano E, Doménech-Pérez C, Martínez-Jabaloyas JM. [Use of prostatic specific antigen in primary care (PSA)]. Semergen 2016; 43:189-195. [PMID: 27344583 DOI: 10.1016/j.semerg.2016.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/06/2016] [Accepted: 04/20/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION In the literature it is shown that the use of PSA is occasionally wrong, by requesting this marker in very young or very old men, and repeated measurements in short periods of time. The main objective of this study was to describe the use of PSA in daily practice by primary care physicians in our area, dealing with aspects such as the importance of patient age, the value in the screening for prostate cancer, or the subjective beliefs about its usefulness. A secondary objective was the comparison of use, and beliefs among doctors who claim to know PSA well, and those who do not. PATIENTS AND METHODS A descriptive and comparative study was conducted using questionnaires that were handed to primary care doctors in all health centres in our area. A descriptive analysis was performed and response rates among doctors who thought they had enough information about PSA, and those who did not, were compared using the Chi-squared test. RESULTS A total of 103 questionnaires were received from the physicians, with 83.5% claiming to have sufficient knowledge about the PSA. The professionals in this latter group request PSA at an earlier age (P=.029), with a higher frequency (P=.011) and have more doubts about its usefulness (P=.009) than those with less knowledge. Almost half (49.5%) said they request less than 50 determinations per year, and 33% between 50 and 100. More than half (53.4%) of doctors would not request the first PSA on a patient until their 50s, and up to 49% request it up to 80 years. The true value of PSA has been established many times by 64.1% of requesters, and 29.1% believe it is unhelpful in the diagnosis of cancer. CONCLUSIONS In our study, 64% of primary care physicians have considered the true value of the PSA several times, and 29% believe it to be of little use in the diagnosis of prostate cancer. In addition, some data suggest it has limited use due to the fact that 50% made less than 50 PSA requests per years, and 28% of the professionals would never request it on a male without urinary symptoms. In this study, it has been observed that those professionals who claim not to have enough information about the PSA make more requests in patients of an older age, and consider that it is of limited use as a marker.
Collapse
Affiliation(s)
- J Panach-Navarrete
- Servicio de Urología, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - A Gironés-Montagud
- Servicio de Urología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - E Sánchez-Cano
- Servicio de Urología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - C Doménech-Pérez
- Servicio de Urología, Hospital Clínico Universitario de Valencia, Valencia, España
| | | |
Collapse
|
2
|
Uysal-Sonmez O, Tanriverdi O, Uyeturk U, Budakoglu II, Kazancioglu R, Turker I, Budakoglu B, Yalcintas-Arslan U, Oksuzoglu B. Awareness of cancer screening during treatment of patients with renal failure: a physician survey in Turkey. Asian Pac J Cancer Prev 2014; 15:2165-8. [PMID: 24716951 DOI: 10.7314/apjcp.2014.15.5.2165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Today, survival rate of patients with chronic renal failure/hemodialysis has increased so that chronic illnesses are more likely to occur. Cancer is the main cause of morbidity and mortality in such patients. AIM In this study, physician attitudes were examined about cancer screening in patients with renal failure. MATERIALS AND METHODS This study was done by face to face questionnaire in the 27th National Nephrology Congress to determine if the physicians dealing with chronic renal failure, hemodialysis or renal transplanted patients, recommend cancer screening or not and the methods of screening for cervix, prostate, breast and colon cancer. RESULTS One hundred and fifty six physicians were included in the survey. A total of 105 (67%) participants were male and the age of responders was 48 ± 9 years. About 29% were specialists in nephrology, 28% internal medicine, and 5% were other areas of expertise. Some 48% of participants were hemodialysis certified general practitioners. Patients were grouped as compensated chronic renal failure, hemodialysis or renal transplanted. Of the 156 responders, 128 (82%) physicians recommended breast cancer screening and the most recommended subgroup was hemodialysis patients (15%). The most preferred methods of screening were combinations of mammography, self breast examination and physician breast examination. 112 (72%) physicians recommended cervix cancer screening, and the most preferred method of screening was pap-smear. Colon cancer screening was recommended by 102 (65%) physicians and prostate screening by 109 (70%) physicians. The most preferred methods of screening were fecal occult blood test and PSA plus rectal digital test, respectively. CONCLUSIONS It is not obvious whether cancer screening in renal failure patients is different from the rest of society. There is a variety of screening methods. An answer can be found to these questions as a result of studies by a common follow-up protocol and cooperation of nephrologists and oncologists.
Collapse
Affiliation(s)
- Ozlem Uysal-Sonmez
- Department of Medical Oncology, Sakarya University Education and Research Hospital, Sakarya, Turkey E-mail : ,
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Wong G, Webster AC, Chapman JR, Craig JC. Reported cancer screening practices of nephrologists: results from a national survey. Nephrol Dial Transplant 2009; 24:2136-43. [DOI: 10.1093/ndt/gfp009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
|
4
|
Gormley GJ, Catney D, McCall JR, Reilly PM, Gavin AT. Prostate-specific antigen testing: uncovering primary care influences. BJU Int 2006; 98:996-1000. [PMID: 17034601 DOI: 10.1111/j.1464-410x.2006.06481.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine influences on the behaviour of General Practitioner (GP) in relation to prostate-specific antigen (PSA) testing. SUBJECTS AND METHODS In Northern Ireland in 2003-2004, all GPs (1067) were invited to complete a self-administered postal questionnaire survey that was then matched with a regional PSA-testing database. The main outcome measures were individual GP responses for demographic, practice and training characteristics, PSA testing behaviour and perceived influences, matched against GP-initiated first PSA tests performed in 2003 and 2004 (22 207 tests). RESULTS In all, 704 GPs (66%) responded and 49% of these reported awareness of the national guidelines, which was highest among those attending postgraduate meetings. PSA tests were more likely to be ordered by full-time male GPs who had attended a local postgraduate urology meeting; ran a 'well-man' clinic; tested men with unrelated complaints; and were not in a training practice. Testing levels were highest among GPs who had been practising for 21-30 years and those in rural practices. Awareness of national guidelines or having had a postgraduate post in urology did not affect testing behaviour. After adjusting for gender, working hours, duration in practice and urban/rural setting, independent influences increasing testing behaviour were: testing men with a positive family history or unrelated complaints; testing any man who requests it; and previous experience of prostate cancer being detected in an asymptomatic patient by PSA testing. Working in an accredited training practice was associated with lower testing levels. CONCLUSION There are complex influences on the PSA testing behaviour of GPs; addressing these influences could contribute to the rationalization of testing. A low awareness of national guidelines indicates a need for new strategies to disseminate and implement guidelines. The influence of local educational meetings on PSA testing is an unharnessed force.
Collapse
Affiliation(s)
- Gerard J Gormley
- Department of General Practice, School of Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | | | | | | |
Collapse
|
5
|
Brett J, Watson E, Hewitson P, Bukach C, Edwards A, Elwyn G, Austoker J. PSA testing for prostate cancer: an online survey of the views and reported practice of General Practitioners in the UK. BMC FAMILY PRACTICE 2005; 6:24. [PMID: 15946386 PMCID: PMC1180431 DOI: 10.1186/1471-2296-6-24] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Accepted: 06/09/2005] [Indexed: 11/10/2022]
Abstract
BACKGROUND The role of Prostate Specific Antigen (PSA) testing in the early detection of prostate cancer is controversial. Current UK policy stipulates that any man who wishes to have a PSA test should have access to the test, provided he has been given full information about the benefits and limitations of testing. This study aimed to determine UK GPs' current reported practice regarding PSA testing, and their views towards informed decision-making and PSA testing. METHOD Online questionnaire survey, with a sample of 421 GPs randomly selected from a database of GPs across the UK. RESULTS 95% (400/421) of GPs responded. 76% of GPs reported having performed a PSA test for an asymptomatic man at least once in the previous three months, with 13% reported having tested more than five men in this period. A majority of GPs reported they would do a PSA test for men presenting with a family history and requesting a test, for asymptomatic men requesting a test and also for men presenting with lower urinary tract symptoms. Reported testing rates were highest for men with a family history. Amongst men with lower urinary tract symptoms and men with no symptoms, reported testing rates were significantly higher for older than younger men. The majority of GPs expressed support for the current policy (67%), and favoured both the general practitioner and the man being involved in the decision making process (83%). 90% of GPs indicated that they would discuss the benefits and limitation of testing with the man, with most (61%) preferring to ask the man to make a further appointment if he decides to be tested. CONCLUSION This study indicates that PSA testing in asymptomatic men is a regular occurrence in the UK, and that there is general support from GPs for the current policy of making PSA tests available to 'informed' men who are concerned about prostate cancer. While most GPs indicated they would discuss the benefits and limitations prior to PSA testing, and most GPs favoured a shared approach to decision making, it is not known to what extent men are actually being informed. Research is needed to evaluate the most effective approach to assisting men in making an informed decision about whether or not to have a PSA test.
Collapse
Affiliation(s)
- Jo Brett
- Cancer Research UK Primary Care Education Research Group, Department of Primary Health Care, Old Road Campus, University of Oxford, Headington, Oxford, OX3 7LF, UK
| | - Eila Watson
- Cancer Research UK Primary Care Education Research Group, Department of Primary Health Care, Old Road Campus, University of Oxford, Headington, Oxford, OX3 7LF, UK
| | - Paul Hewitson
- Cancer Research UK Primary Care Education Research Group, Department of Primary Health Care, Old Road Campus, University of Oxford, Headington, Oxford, OX3 7LF, UK
| | - Colleen Bukach
- Cancer Research UK Primary Care Education Research Group, Department of Primary Health Care, Old Road Campus, University of Oxford, Headington, Oxford, OX3 7LF, UK
| | - Adrian Edwards
- Centre for Health Sciences Research, Cardiff University, 56 Park Place, Cardiff, CF10 3AT, UK
| | - Glyn Elwyn
- Centre for Health Sciences Research, Cardiff University, 56 Park Place, Cardiff, CF10 3AT, UK
| | - Joan Austoker
- Cancer Research UK Primary Care Education Research Group, Department of Primary Health Care, Old Road Campus, University of Oxford, Headington, Oxford, OX3 7LF, UK
| |
Collapse
|
6
|
Gattellari M, Donnelly N, Taylor N, Meerkin M, Hirst G, Ward JE. Does 'peer coaching' increase GP capacity to promote informed decision making about PSA screening? A cluster randomised trial. Fam Pract 2005; 22:253-65. [PMID: 15824055 DOI: 10.1093/fampra/cmi028] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Very little effort has been directed to enable GPs to better informed decisions about PSA screening among their male patients. OBJECTIVES To evaluate an innovative programme designed to enhance GPs' capacity to promote informed decision making by male patients about PSA screening. METHODS The study design was a cluster randomised controlled trial set in New South Wales, Australia's most populous state. 277 GPs were recruited through a major pathology laboratory. The interventions were three telephone-administered 'peer coaching' sessions integrated with educational resources for GPs and patients and the main outcome measures were: GP knowledge; perceptions of patient involvement in informed decision making; GPs' own decisional conflict; and perceptions of medicolegal risk. RESULTS Compared with GPs allocated to the control group, GPs allocated to our intervention gained significantly greater knowledge about PSA screening and related information [Mean 6.1 out of 7; 95% confidence interval (CI) = 5.9-6.3 versus 4.8; 95% CI = 4.6-5.0; P < 0.001]. They were less likely to agree that patients should remain passive when making decisions about PSA screening [Odds ratio (OR) = 0.11; 95% CI = 0.04-0.31; P < 0.001]. They perceived less medicolegal risk when not acceding to an 'uninformed' patient request for a PSA test (OR = 0.31; 95% CI 0.19-0.51). They also demonstrated lower levels of personal decisional conflict about the PSA screening (Mean 25.4; 95% CI 24.5-26.3 versus 27.8; 95% CI 26.6-29.0; P = 0.0002). CONCLUSION A 'peer coaching' programme, supplemented by education materials, holds promise as a strategy to equip GPs to facilitate informed decision making amongst their patients.
Collapse
Affiliation(s)
- Melina Gattellari
- School of Public Health and Community Medicine, University of New South Wales and Centre for Research, Evidence Management and Serveillance, South Western Sydney Area Health Service, Liverpool, NSW 1871, Australia.
| | | | | | | | | | | |
Collapse
|
7
|
Gattellari M, Young JM, Ward JE. GP and patient predictors of PSA screening in Australian general practice. Fam Pract 2003; 20:294-303. [PMID: 12738699 DOI: 10.1093/fampra/cmg311] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We determined GP and patient variables associated first with men's prior uptake of prostate-specific antigen (PSA) screening and, subsequently, its initiation during an 'index consultation' in Australian general practice. METHODS From the practices of 60 GPs, we recruited a sample of 423 male patients aged 40-70 years. In a waiting room questionnaire completed before their 'index consultation' (retrospective component), men reported their previous PSA screening status. We obtained demographic and clinical data, including the presence of lower urinary tract symptoms (LUTS). Men also were mailed a questionnaire 2 days after their 'index consultation' to ascertain whether the GP had discussed PSA screening (prospective component) for prostate cancer and other behaviours. GPs themselves completed questionnaires eliciting demographic and practice characteristics as well as their propensity to screen and understanding of the evidence about PSA testing. GP and patient study variables were modelled simultaneously in analyses. RESULTS Of those 348 men consulting with their regular GP, 80 (23.0%) reported previously having had a PSA screening test. Men were significantly and independently more likely ever to have had PSA screening if their regular GP reported a propensity to initiate screening [adjusted odds ratio (AOR) = 2.27, 95% confidence interval (CI) 1.23-4.20; P = 0.009]. GP age also was independently associated with men's PSA screening status [chi-squared (3) P < 0.0001] as was men's age and severity of LUTS (AOR = 2.38, 95% CI 1.58-3.57, P < 0.0001 and AOR = 1.79, 95% CI 1.00-3.19, P = 0.004, respectively). Current smokers were less likely ever to have had a PSA screening test (AOR = 0.34, 95% CI 0.16-0.69; P = 0.003). Discussion of PSA screening in their 'index consultation' was recalled independently more often by older men (AOR = 1.46, 95% CI 1.00-2.13; P = 0.04), those with moderate/severe LUTS (AOR = 1.94, 1.07-3.49; P = 0.04), those whose GP had performed or discussed a cholesterol test (AOR = 2.26, 95% CI 1.03-4.92; P = 0.04) and those whose GP had postgraduate training in family medicine (AOR = 3.13, 95% CI 1.23-8.00; P = 0.02). CONCLUSION In the absence as yet of compelling evidence that PSA screening will prolong life or enhance its quality, our findings identify GP and patient factors that could be targeted to modify PSA screening.
Collapse
Affiliation(s)
- Melina Gattellari
- Division of Population Health, South Western Sydney Area Health Service, School of Public Health, University of Sydney, Sydney, Australia
| | | | | |
Collapse
|
8
|
Quinn DI, Henshall SM, Haynes AM, Brenner PC, Kooner R, Golovsky D, Mathews J, O'Neill GF, Turner JJ, Delprado W, Finlayson JF, Sutherland RL, Grygiel JJ, Stricker PD. Prognostic significance of pathologic features in localized prostate cancer treated with radical prostatectomy: implications for staging systems and predictive models. J Clin Oncol 2001; 19:3692-705. [PMID: 11504751 DOI: 10.1200/jco.2001.19.16.3692] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although predicting outcome for men with clinically localized prostate cancer (PC) has improved, the staging system and nomograms used to do this are based on results from the North American health system. To be internationally applicable, these models require testing in cohorts from a variety of different health systems based on the predominant PC case identification methods used. PATIENTS AND METHODS We studied 732 men with localized PC treated with radical prostatectomy and no preoperative therapy between 1986 and 1999 at one Australian institution to determine the effect of clinicopathologic features on disease-free survival. RESULTS Preoperative serum prostate-specific antigen (PSA) concentration, Gleason score, pathologic stage, and year of surgery were independent predictors of outcome. Although margin status demonstrated only a trend toward significance in multivariate modeling overall, it proved to be independent in subgroups based on later year of surgery (1986 to 1994 v 1995 to 1998), preoperative PSA of less than 10 ng/mL, and Gleason score > or = 7. Adjuvant radiation therapy improved disease-free survival rates in patients with multiple surgical margin involvement. CONCLUSION This work confirms the prognostic significance of pathologic stage, Gleason score, and preoperative serum PSA. In the context of a contemporaneous screening effect in Australia, these findings may have implications for methods that predict outcome following surgery as screening becomes more prevalent in a population. The independent prognostic effect of margin status may alter with an increase in the proportion of screening-identified PCs. Staging systems and nomograms that predict outcome following surgery require validation in cohorts with different health practices before being universally applied.
Collapse
Affiliation(s)
- D I Quinn
- Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Girgis S, Ward JE, Thomson CJ. General practitioners' perceptions of medicolegal risk. Using case scenarios to assess the potential impact of prostate cancer screening guidelines. Med J Aust 1999; 171:362-6. [PMID: 10590725 DOI: 10.5694/j.1326-5377.1999.tb123693.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To ascertain general practitioners' perceptions of medicolegal risk when screening for prostate cancer, and explore the potential impact of three national guidelines on perceptions and clinical practice. DESIGN Postal survey in August 1997. PARTICIPANTS 219 randomly selected GPs in New South Wales (65% response rate). MAIN OUTCOME MEASURES Response to case scenarios; perceptions of medicolegal risk and protection afforded by national guidelines before and after reading extracts of three national guidelines; ratings of current and potential strategies to increase GPs' sense of medicolegal protection. RESULTS 90% (95% CI, 86.5%-94.3%) would screen an asymptomatic male patient and 61% (95% CI, 54.2%-67.2%) indicated GPs would be at risk if they did not screen. Although significant changes in responses were found after respondents had read guideline extracts, 46% (95% CI, 39.5%-52.7%) continued to perceive medicolegal risk if screening was not performed. About two-thirds (65%; 95% CI, 59.9%-72.5%) supported a clear statement about the legal status of guidelines in a court of law to increase their sense of medicolegal protection. CONCLUSIONS Even when made aware of national evidence-based guidelines against prostate cancer screening, GPs in our survey perceived limited hypothetical medicolegal protection.
Collapse
Affiliation(s)
- S Girgis
- Needs Assessment and Health Outcomes Unit, Central Sydney Area Health Service, Newtown, NSW
| | | | | |
Collapse
|
10
|
Slevin TJ, Donnelly N, Clarkson JP, English DR, Ward JE. Prostate cancer testing: behaviour, motivation and attitudes among Western Australian men. Med J Aust 1999; 171:185-8. [PMID: 10494233 DOI: 10.5694/j.1326-5377.1999.tb123594.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the proportion of Western Australian men aged 40-80 years who had been tested for prostate cancer, their experiences of screening and perception of its benefit. DESIGN AND SETTING Cross-sectional survey (random telephone survey) of Western Australian men conducted in February 1998. PARTICIPANTS 400 men aged 40-80 years from 670 eligible households (60% response rate from contactable households with eligible men). MAIN OUTCOME MEASURES Proportion of respondents tested for prostate cancer (by prostate-specific antigen [PSA] test or digital rectal examination); reasons for having been tested; information provided by the doctor before testing; reasons given for and beliefs about the benefits of testing. RESULTS Of 391 asymptomatic men, 220 (56%) recalled having been tested for prostate cancer and 167 (43%) had had a PSA test. Of those tested, 86% had their first test in the previous five years. The two most common reasons for testing were media publicity and general practitioner recommendation. Thirty-eight per cent of men tested during the previous five years reported that the doctor did not discuss the "pros and cons" of the test; 39% reported a discussion of less than five minutes' duration; 17% were given printed information before undergoing the test for the first time. Half were "very convinced" of the benefits of testing for prostate cancer. CONCLUSIONS Men are being tested for prostate cancer with minimal pretest counselling or written information.
Collapse
Affiliation(s)
- T J Slevin
- Cancer Foundation of Western Australia, Perth.
| | | | | | | | | |
Collapse
|
11
|
Abstract
STUDY OBJECTIVES To determine family physicians' perceptions of the effectiveness of chest radiographs (CXRs) in reducing premature mortality from lung cancer and their self-reported levels of screening asymptomatic heavy smokers. DESIGN National postal survey of 1,271 family physicians, obtaining 855 completed questionnaires (67% response rate). SETTING AND PARTICIPANTS Random sample of Australian family physicians. MEASUREMENTS AND RESULTS One in five (n = 169, 20%) indicated that an annual CXR was an effective screening test. Older physicians were significantly more likely to hold this view (p < 0.0001). Nearly 25% (n = 190, 22.5%) reported that they recommend an annual CXR as a screening test for asymptomatic heavy smokers. Three variables independently predicted such a practice: increasing physician age (p = 0.0085), being in solo practice (p = 0.0068), and the aforementioned belief in its effectiveness (p < 0.0001). CONCLUSIONS A substantial minority of family physicians recommends an annual CXR as a screening test despite contradictory evidence from randomized controlled trials. These significant variations in the absence of epidemiologic evidence invite further research to develop effective, efficient, and affordable preventive care in family practice.
Collapse
Affiliation(s)
- M J Sladden
- Division of Community and Rural Health, University of Tasmania, Hobart, Australia.
| | | |
Collapse
|
12
|
Young JM, Ward JE, Holt P. Breast cancer screening in Australian general practice: results of a national survey. Med J Aust 1998; 169:364-8. [PMID: 9803248 DOI: 10.5694/j.1326-5377.1998.tb126804.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine current beliefs and knowledge about, and use of, two screening tests for breast cancer (mammography and clinical breast examination [CBE]) among general practitioners (GPs). DESIGN, PARTICIPANTS AND SETTING National postal survey of randomly selected GPs from throughout Australia in May 1996. MAIN OUTCOME MEASURES Belief in the effectiveness of each screening test in reducing premature deaths from breast cancer; recommended age group and screening interval for each test; likelihood of including each opportunistically or in a health check-up. Predictors were determined by regression analyses. RESULTS The response rate was 67% (855/1271). Significantly more respondents believed in the effectiveness of mammography than of CBE (92% v. 66%). About half identified women 50 years and over as the appropriate target group for mammography. Only 40% indicated they would be "highly likely" to discuss mammography opportunistically, although 82% would be "highly likely" to discuss it in a health check-up. After adjusting for confounders, female GPs were more likely to discuss mammographic screening and to advocate a biennial frequency. Older GPs and those from New South Wales were least likely to recommend mammography (consistent with the national policy). Significantly more respondents were "highly likely" to discuss CBE than mammography in a health check-up. CONCLUSIONS GPs are convinced of the effectiveness of mammography, but as respondents were more likely to screen by CBE than to recommend mammography in a dedicated health check-up a consistent national policy about CBE would be highly desirable.
Collapse
Affiliation(s)
- J M Young
- Needs Assessment & Health Outcomes Unit, Central Sydney Area Health Service, NSW
| | | | | |
Collapse
|