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Amornsiripanitch N, Ameri SM, Goldberg RJ. Primary Care Providers Underutilize Breast Screening MRI for High-Risk Women. Curr Probl Diagn Radiol 2020; 50:489-494. [PMID: 32546344 DOI: 10.1067/j.cpradiol.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/23/2020] [Accepted: 04/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Supplemental MRI screening for women at high risk for breast cancer is underutilized. Our study assessed how primary care providers in our healthcare network identify high-risk women and recommend high-risk screening breast MRI. METHODS An electronic survey was distributed to providers in OB/GYN, family, and internal medicine departments between 1/14/19 and 3/22/19. The survey inquired about methods used to assess breast cancer risk, familiarity with the American Cancer Society's definition of high-risk, and whether screening breast MRI is recommended for high-risk women. RESULTS Response rate was 17% (89/524). After excluding providers who ordered ≤10 mammograms per year, the study included 75 respondents, who mostly ordered 10-1000 mammograms per year and supported annual/biennial screening mammogram starting at age 40-50 years. More providers reported estimating breast cancer risk qualitatively (with family, clinical history, and/or breast density) than quantitatively with risk calculators (73/75, 97% vs 22/75, 29%). A minority of providers (23/75, 31%) correctly defined high lifetime risk. Only 9/75 (12%) providers recommended screening MRI for high-risk women. Use of quantitative risk calculators or ability to correctly define high-risk were not associated with likelihood of recommending MRI screening. More providers had recommended MRI for screening in the setting of dense breasts than for high-risk screening (23/75, 31% vs 9/75, 12%). CONCLUSION Primary care providers at our institution did not routinely recommend screening MRI for high-risk women. Risk assessment and reporting at the time of mammography may improve MRI utilization and is an opportunity for radiologists to add value and directly participate in patient-centered care.
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Affiliation(s)
| | - S M Ameri
- University of Massachusetts Medical School, Worcester, MA
| | - R J Goldberg
- University of Massachusetts Medical School, Worcester, MA
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Samimi G, Heckman-Stoddard BM, Holmberg C, Tennant B, Sheppard BB, Coa KI, Kay SS, Ford LG, Szabo E, Minasian LM. Cancer Prevention in Primary Care: Perception of Importance, Recognition of Risk Factors and Prescribing Behaviors. Am J Med 2020; 133:723-732. [PMID: 31862335 PMCID: PMC7293933 DOI: 10.1016/j.amjmed.2019.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Acceptability and uptake of cancer preventive interventions is associated with physician recommendation, which is dependent on physician familiarity with available preventive options. The goal of this study is to evaluate cancer prevention perceptions, understanding of breast and ovarian cancer risk factors, and prescribing behaviors of primary care physicians. METHODS We conducted cross-sectional. Web-based survey of 750 primary care physicians (250 each for obstetrics/gynecology, internal medicine, and family medicine) in the United States. Survey respondents were recruited from an opt-in health care provider panel. RESULTS Perception of importance and the practice of recommending general and cancer-specific preventive screenings and interventions significantly differed by provider type. These perceptions and behaviors reflected the demographics of the population that the primary care physicians see within their respective practices. The majority of respondents recognized genetic/hereditary risk factors for breast or ovarian cancer, while epidemiologic or clinical risk factors were less frequently recognized. Prescribing behaviors were related to familiarity with the interventions, with physicians indicating that they more frequently reinforced a specialist's recommendation rather than prescribed a preventive intervention. CONCLUSIONS Cancer prevention perceptions, recognition of cancer risk factors, and prescribing behaviors differ among practice types and were related to familiarity with preventive options. Cancer prevention education and risk assessment resources should be more widely available to primary care physicians.
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Affiliation(s)
- Goli Samimi
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD.
| | | | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg, Havel, Germany
| | | | | | | | | | - Leslie G Ford
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
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3
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Customized breast cancer risk assessment in an ambulatory clinic: a portal for identifying women at risk. Breast Cancer Res Treat 2019; 175:229-237. [DOI: 10.1007/s10549-018-05116-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022]
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Amara N, Blouin-Bougie J, Jbilou J, Halilem N, Simard J, Landry R. The knowledge value-chain of genetic counseling for breast cancer: an empirical assessment of prediction and communication processes. Fam Cancer 2016; 15:1-17. [PMID: 26334522 DOI: 10.1007/s10689-015-9835-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this paper is twofold: to analyze the genetic counseling process for breast cancer with a theoretical knowledge transfer lens and to compare generalists, medical specialists, and genetic counselors with regards to their genetic counseling practices. This paper presents the genetic counseling process occurring within a chain of value-adding activities of four main stages describing health professionals' clinical practices: (1) evaluation, (2) investigation, (3) information, and (4) decision. It also presents the results of a cross-sectional study based on a Canadian medical doctors and genetic counselors survey (n = 176) realized between July 2012 and March 2013. The statistical exercise included descriptive statistics, one-way ANOVA and post-hoc tests. The results indicate that even though all types of health professionals are involved in the entire process of genetic counseling for breast cancer, genetic counselors are more involved in the evaluation of breast cancer risk, while medical doctors are more active in the decision toward breast cancer risk management strategies. The results secondly demonstrate the relevance and the key role of genetic counselors in the care provided to women at-risk of familial breast cancer. This paper presents an integrative framework to understand the current process of genetic counseling for breast cancer in Canada, and to shed light on how and where health professionals contribute to the process. It also offers a starting point for assessing clinical practices in genetic counseling in order to establish more clearly where and to what extent efforts should be undertaken to implement future genetic services.
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Affiliation(s)
- Nabil Amara
- Department of Management, Pavillon Palasis-Prince, Laval University, 2325, rue de la Terrasse, Local 1516, Quebec, QC, G1V 0A6, Canada.
| | - Jolyane Blouin-Bougie
- Department of Management, Pavillon Palasis-Prince, Laval University, 2325, rue de la Terrasse, Local 1516, Quebec, QC, G1V 0A6, Canada.
| | - Jalila Jbilou
- New Brunswick Medical Training Centre and School of Psychology, University of Monction, Moncton, NB, Canada.
| | - Norrin Halilem
- Department of Management, Pavillon Palasis-Prince, Laval University, 2325, rue de la Terrasse, Local 1516, Quebec, QC, G1V 0A6, Canada.
| | - Jacques Simard
- Cancer Genomics Laboratory, Department of Molecular Medicine, Laval University, Quebec, QC, Canada.
| | - Réjean Landry
- Department of Management, Pavillon Palasis-Prince, Laval University, 2325, rue de la Terrasse, Local 1516, Quebec, QC, G1V 0A6, Canada.
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Brewster AM, Davidson NE, McCaskill-Stevens W. Chemoprevention for breast cancer: overcoming barriers to treatment. Am Soc Clin Oncol Educ Book 2016:85-90. [PMID: 24451714 DOI: 10.14694/edbook_am.2012.32.152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Evidence from placebo-controlled, randomized clinical trials supports the use of chemoprevention in women at high risk for developing breast cancer, and two agents-tamoxifen and raloxifene-are U.S. Food and Drug Administration (FDA)-approved for the indication. Despite clinical guidelines that recommend physicians counsel high-risk women about the use of chemoprevention and the estimated 2.4 million women in the United States who meet eligibility criteria for net benefit, the uptake of breast cancer chemoprevention has been exceedingly low. Assessments of the risks and benefits of chemoprevention are aided by the availability of models that can be used to estimate of the risk-benefit ratio. However, many physicians remain unaware of these resources to determine patient eligibility for chemoprevention and lack the time to provide informed counseling to their patients. The barriers for patients' acceptance of chemoprevention treatment include fear of side effects and the perception that chemoprevention will not substantially lower their risk of developing breast cancer. Despite these challenges, there are substantial opportunities to increase the utilization of chemoprevention. These strategies include education, dissemination of user-friendly risk-benefit models, and the support of research efforts focused on identifying biomarkers that can more accurately select women most likely to develop breast cancer and predict responsiveness of treatment.
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Affiliation(s)
- Abenaa M Brewster
- From the University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Pittsburgh Cancer Institute, Pittsburgh, PA; and National Cancer Institute, Bethesda, MD
| | - Nancy E Davidson
- From the University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Pittsburgh Cancer Institute, Pittsburgh, PA; and National Cancer Institute, Bethesda, MD
| | - Worta McCaskill-Stevens
- From the University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Pittsburgh Cancer Institute, Pittsburgh, PA; and National Cancer Institute, Bethesda, MD
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Corbelli J, Borrero S, Bonnema R, McNamara M, Kraemer K, Rubio D, Karpov I, McNeil M. Use of the Gail model and breast cancer preventive therapy among three primary care specialties. J Womens Health (Larchmt) 2014; 23:746-52. [PMID: 25115368 DOI: 10.1089/jwh.2014.4742] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Breast cancer is an issue of serious concern among women of all ages. The extent to which providers across primary care specialties assess breast cancer risk and discuss chemoprevention is unknown. METHODS Cross-sectional web-based survey completed by 316 physicians in internal medicine (IM), family medicine (FM), and gynecology (GYN) from February to April of 2012. Survey items assessed respondents' frequency of use of the Gail model and chemoprevention, and their attitudes behind practice patterns. Descriptive statistics were used to generate response distributions, and chi-squared tests were used to compare responses among specialties. RESULTS The response rate was 55.0 % (316/575). Only 40% of providers report having used the Gail model (37% IM, 33% FM, 60% GYN) and 13% report having recommended or prescribed chemoprevention (9% IM, 8% FM, 30% GYN). Among providers who use the Gail model, a minority use it regularly in patients who may be at increased breast cancer risk. Among providers who have prescribed chemoprevention, most have done so five times or fewer. Lack of both time and familiarity were commonly cited barriers to use of the Gail score and chemoprevention. CONCLUSIONS An overall minority of providers, most notably in FM and IM, use the Gail model to assess, and chemoprevention to decrease, breast cancer risk. Until providers are more consistent in their use of the Gail model (or other breast cancer risk calculator) and chemoprevention, opportunities to intervene in women at increased risk will likely continue to be missed.
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Affiliation(s)
- Jennifer Corbelli
- 1 Division of General Internal Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
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Corbelli J, Borrero S, Bonnema R, McNamara M, Kraemer K, Rubio D, Karpov I, McNeil M. Physician adherence to U.S. Preventive Services Task Force mammography guidelines. Womens Health Issues 2014; 24:e313-9. [PMID: 24794545 DOI: 10.1016/j.whi.2014.03.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND In 2009, the U.S. Preventive Services Task Force (USPSTF) guidelines for screening mammography changed significantly, and are now in direct conflict with screening guidelines of other major national organizations. The extent to which physicians in different primary care specialties adhere to current USPSTF guidelines is unknown. METHODS We conducted a cross-sectional web-based survey completed by 316 physicians in internal medicine, family medicine (FM), and gynecology (GYN) from February to April 2012. Survey items assessed respondents' breast cancer screening recommendations in women of different ages at average risk for breast cancer. We used descriptive statistics to generate response distribution for survey items, and logistic regression models to compare responses among specialties. FINDINGS The response rate was 55.0% (316/575). A majority of providers in internal medicine (65%), FM (64%), and GYN (92%) recommended breast cancer screening starting at age 40 versus 50. A majority of providers in internal medicine (77%), FM (74%), and GYN (98%) recommended annual versus biennial screening. Gynecologists were significantly more likely than both internists and family physicians to recommend initial mammography at age 40 (p ≤ .0001) and yearly mammography (p = .0003). There were no other differences by respondent demographic. CONCLUSIONS Primary care providers, especially gynecologists, have not implemented USPSTF guidelines. The extent to which these findings may be driven by patient versus provider preferences should be explored. These findings suggest that patients are likely to receive conflicting breast cancer screening recommendations from different providers.
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Affiliation(s)
- Jennifer Corbelli
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Sonya Borrero
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Research Health Equity and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Rachel Bonnema
- Division of General Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Megan McNamara
- Division of General Internal Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; Louis Stokes VA Healthcare System, Cleveland, Ohio
| | - Kevin Kraemer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Doris Rubio
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Irina Karpov
- Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Melissa McNeil
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Jbilou J, Halilem N, Blouin-Bougie J, Amara N, Landry R, Simard J. Medical genetic counseling for breast cancer in primary care: a synthesis of major determinants of physicians' practices in primary care settings. Public Health Genomics 2014; 17:190-208. [PMID: 24993835 DOI: 10.1159/000362358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/20/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This paper aims to identify relevant potential predictors of medical genetic counseling for breast cancer (MGC-BC) in primary care and to develop a comprehensive questionnaire to study MGC-BC. METHODS A scoping review was conducted to identify the predictors of MGC-BC among primary care physicians. Relevant articles were identified in selected databases (PubMed, Embase, CINAHL, ISI Web of Science, PsycINFO, and Cochrane CENTRAL) and 4 selected relevant electronic journals. RESULTS An inductive analysis of the 193 quantitatively tested variables, conducted by 3 researchers, showed that 6 conceptual categories of determinants, namely (1) demographic, (2) organizational, (3) experiential, (4) professional, (5) psychological, and (6) cognitive, influence MGC-BC practices. CONCLUSION There is a scarcity of literature addressing the medical behavior determinants of MGC-BC. Future research is needed to identify effective strategies put into action to support the integration of MGC-BC in primary care medical practices and routines. However, our results shed light on 2 levels of actions that could improve genetic counseling services in primary care: (1) medical training and educational efforts emphasizing family history collection (individual level), and (2) clarification of roles and responsibilities in ordering and referral practices in genetic counseling and genetic testing for better healthcare management (organizational level).
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Affiliation(s)
- Jalila Jbilou
- Centre de formation médicale du Nouveau-Brunswick, Université de Moncton, Moncton, N.B., Canada
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Bolton KC, Mace JL, Vacek PM, Herschorn SD, James TA, Tice JA, Kerlikowske K, Geller BM, Weaver DL, Sprague BL. Changes in breast cancer risk distribution among Vermont women using screening mammography. J Natl Cancer Inst 2014; 106:dju157. [PMID: 24957223 DOI: 10.1093/jnci/dju157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Screening mammography utilization in Vermont has declined since 2009 during a time of changing screening guidelines and increased interest in personalized screening regimens. This study evaluates whether the breast cancer risk distribution of the state's screened population changed during the observed decline. METHODS We examined the breast cancer risk distribution among screened women between 2001 and 2012 using data from the Vermont Breast Cancer Surveillance System. We estimated each screened woman's 5-year risk of breast cancer using the Breast Cancer Surveillance Consortium risk calculator. Annual screening counts by risk group were normalized and age-adjusted to the Vermont female population by direct standardization. RESULTS The normalized rate of low-risk (5-year breast cancer risk of <1%) women screened increased 8.3% per year (95% confidence interval [CI] = 4.8 to 11.9) between 2003 and 2008 and then declined by -5.4% per year (95% CI = -8.1 to -2.6) until 2012. When stratified by age group, the rate of low-risk women screened declined -4.4% per year (95% CI = -8.8 to 0.1; not statistically significant) for ages 40 to 49 years and declined a statistically significant -7.1% per year (95% CI = -12.1 to -2.0) for ages 50 to 74 years during 2008 to 2012. These declines represented the bulk of overall decreases in screening after 2008, with rates for women categorized in higher risk levels generally exhibiting small annual changes. CONCLUSIONS The observed decline in women screened in Vermont in recent years is largely attributable to reductions in screening visits by women who are at low risk of developing breast cancer.
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Affiliation(s)
- Kenyon C Bolton
- Affiliations of authors: Office of Health Promotion Research (KCB, JLM, BMG, BLS), Department of Biostatistics (PMV), Vermont Cancer Center (PMV, SDH, TAJ, DLW, BLS), Department of Radiology (SDH), Department of Surgery (TAJ, BLS), Department of Family Medicine (BMG), and Department of Pathology (DLW), University of Vermont, Burlington, VT; Departments of Medicine and Epidemiology and Biostatistics (JAT, KK), and General Internal Medicine Section (KK), Department of Veterans Affairs, University of California, San Francisco, CA
| | - John L Mace
- Affiliations of authors: Office of Health Promotion Research (KCB, JLM, BMG, BLS), Department of Biostatistics (PMV), Vermont Cancer Center (PMV, SDH, TAJ, DLW, BLS), Department of Radiology (SDH), Department of Surgery (TAJ, BLS), Department of Family Medicine (BMG), and Department of Pathology (DLW), University of Vermont, Burlington, VT; Departments of Medicine and Epidemiology and Biostatistics (JAT, KK), and General Internal Medicine Section (KK), Department of Veterans Affairs, University of California, San Francisco, CA
| | - Pamela M Vacek
- Affiliations of authors: Office of Health Promotion Research (KCB, JLM, BMG, BLS), Department of Biostatistics (PMV), Vermont Cancer Center (PMV, SDH, TAJ, DLW, BLS), Department of Radiology (SDH), Department of Surgery (TAJ, BLS), Department of Family Medicine (BMG), and Department of Pathology (DLW), University of Vermont, Burlington, VT; Departments of Medicine and Epidemiology and Biostatistics (JAT, KK), and General Internal Medicine Section (KK), Department of Veterans Affairs, University of California, San Francisco, CA
| | - Sally D Herschorn
- Affiliations of authors: Office of Health Promotion Research (KCB, JLM, BMG, BLS), Department of Biostatistics (PMV), Vermont Cancer Center (PMV, SDH, TAJ, DLW, BLS), Department of Radiology (SDH), Department of Surgery (TAJ, BLS), Department of Family Medicine (BMG), and Department of Pathology (DLW), University of Vermont, Burlington, VT; Departments of Medicine and Epidemiology and Biostatistics (JAT, KK), and General Internal Medicine Section (KK), Department of Veterans Affairs, University of California, San Francisco, CA
| | - Ted A James
- Affiliations of authors: Office of Health Promotion Research (KCB, JLM, BMG, BLS), Department of Biostatistics (PMV), Vermont Cancer Center (PMV, SDH, TAJ, DLW, BLS), Department of Radiology (SDH), Department of Surgery (TAJ, BLS), Department of Family Medicine (BMG), and Department of Pathology (DLW), University of Vermont, Burlington, VT; Departments of Medicine and Epidemiology and Biostatistics (JAT, KK), and General Internal Medicine Section (KK), Department of Veterans Affairs, University of California, San Francisco, CA
| | - Jeffrey A Tice
- Affiliations of authors: Office of Health Promotion Research (KCB, JLM, BMG, BLS), Department of Biostatistics (PMV), Vermont Cancer Center (PMV, SDH, TAJ, DLW, BLS), Department of Radiology (SDH), Department of Surgery (TAJ, BLS), Department of Family Medicine (BMG), and Department of Pathology (DLW), University of Vermont, Burlington, VT; Departments of Medicine and Epidemiology and Biostatistics (JAT, KK), and General Internal Medicine Section (KK), Department of Veterans Affairs, University of California, San Francisco, CA
| | - Karla Kerlikowske
- Affiliations of authors: Office of Health Promotion Research (KCB, JLM, BMG, BLS), Department of Biostatistics (PMV), Vermont Cancer Center (PMV, SDH, TAJ, DLW, BLS), Department of Radiology (SDH), Department of Surgery (TAJ, BLS), Department of Family Medicine (BMG), and Department of Pathology (DLW), University of Vermont, Burlington, VT; Departments of Medicine and Epidemiology and Biostatistics (JAT, KK), and General Internal Medicine Section (KK), Department of Veterans Affairs, University of California, San Francisco, CA
| | - Berta M Geller
- Affiliations of authors: Office of Health Promotion Research (KCB, JLM, BMG, BLS), Department of Biostatistics (PMV), Vermont Cancer Center (PMV, SDH, TAJ, DLW, BLS), Department of Radiology (SDH), Department of Surgery (TAJ, BLS), Department of Family Medicine (BMG), and Department of Pathology (DLW), University of Vermont, Burlington, VT; Departments of Medicine and Epidemiology and Biostatistics (JAT, KK), and General Internal Medicine Section (KK), Department of Veterans Affairs, University of California, San Francisco, CA
| | - Donald L Weaver
- Affiliations of authors: Office of Health Promotion Research (KCB, JLM, BMG, BLS), Department of Biostatistics (PMV), Vermont Cancer Center (PMV, SDH, TAJ, DLW, BLS), Department of Radiology (SDH), Department of Surgery (TAJ, BLS), Department of Family Medicine (BMG), and Department of Pathology (DLW), University of Vermont, Burlington, VT; Departments of Medicine and Epidemiology and Biostatistics (JAT, KK), and General Internal Medicine Section (KK), Department of Veterans Affairs, University of California, San Francisco, CA
| | - Brian L Sprague
- Affiliations of authors: Office of Health Promotion Research (KCB, JLM, BMG, BLS), Department of Biostatistics (PMV), Vermont Cancer Center (PMV, SDH, TAJ, DLW, BLS), Department of Radiology (SDH), Department of Surgery (TAJ, BLS), Department of Family Medicine (BMG), and Department of Pathology (DLW), University of Vermont, Burlington, VT; Departments of Medicine and Epidemiology and Biostatistics (JAT, KK), and General Internal Medicine Section (KK), Department of Veterans Affairs, University of California, San Francisco, CA.
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Corbelli J, Borrero S, Bonnema R, McNamara M, Kraemer K, Rubio D, Karpov I, McNeil M. Differences Among Primary Care Physicians' Adherence to 2009 ACOG Guidelines for Cervical Cancer Screening. J Womens Health (Larchmt) 2014; 23:397-403. [DOI: 10.1089/jwh.2013.4475] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jennifer Corbelli
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sonya Borrero
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Research Health Equity and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Rachel Bonnema
- University of Nebraska Medical Center Division of General Internal Medicine, Omaha, Nebraska
| | - Megan McNamara
- Case Western Reserve University School of Medicine Division of General Internal Medicine, Cleveland, Ohio
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Kevin Kraemer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Doris Rubio
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Irina Karpov
- Center for Research on Health Care, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania
| | - Melissa McNeil
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Accuracy of ovarian and colon cancer risk assessments by U.S. physicians. J Gen Intern Med 2014; 29:741-9. [PMID: 24519100 PMCID: PMC4000350 DOI: 10.1007/s11606-014-2768-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 11/20/2013] [Accepted: 12/11/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Studies have shown a mismatch between published cancer screening and genetic counseling referral recommendations and physician-reported screening and referral practices. Inaccurate cancer risk assessment is one potential cause of this mismatch. OBJECTIVE To assess U.S. physicians' ability to accurately determine a woman's colon and ovarian cancer risk level. DESIGN, PARTICIPANTS Cross-sectional survey of U.S. family physicians, general internists, and obstetrician-gynecologists. A twelve-page questionnaire with a vignette of a woman's annual examination included a question about the patient's level of colon and ovarian cancer risk. The final study sample included 1,555 physicians weighted to represent practicing U.S. physicians nationally. MAIN MEASURE Accuracy of physicians' ovarian and colon cancer risk assessments. KEY RESULTS Overall, most physicians accurately assessed women's risk of ovarian (57.0%, CI 54.3, 59.6) and colon cancer (62.0%, CI 59.4, 64.6). However, 27.1% (CI 23.0, 31.6) of physicians overestimated the ovarian cancer risk among women at the same risk as the general population, and 65.1% (CI 60.2, 69.7) underestimated ovarian cancer risk among women at much higher risk than the general population. Physicians overestimated colon more than ovarian cancer risk (38.0%, CI 35.4, 40.6 vs. 27.1%, CI 23.0, 31.6) for women at the same risk as the general population. CONCLUSIONS Physicians' misestimation of patient ovarian and colon cancer risk may put average risk patients in jeopardy of unnecessary screening and higher risk patients in jeopardy of missed opportunities for prevention or early detection of cancers.
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Wernli KJ, DeMartini WB, Ichikawa L, Lehman CD, Onega T, Kerlikowske K, Henderson LM, Geller BM, Hofmann M, Yankaskas BC. Patterns of breast magnetic resonance imaging use in community practice. JAMA Intern Med 2014; 174:125-32. [PMID: 24247555 PMCID: PMC3905972 DOI: 10.1001/jamainternmed.2013.11963] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Breast magnetic resonance imaging (MRI) is increasingly used for breast cancer screening, diagnostic evaluation, and surveillance. However, we lack data on national patterns of breast MRI use in community practice. OBJECTIVE To describe patterns of breast MRI use in US community practice during the period 2005 through 2009. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study using data collected from 2005 through 2009 on breast MRI and mammography from 5 national Breast Cancer Surveillance Consortium registries. Data included 8931 breast MRI examinations and 1,288,924 screening mammograms from women aged 18 to 79 years. MAIN OUTCOMES AND MEASURES We calculated the rate of breast MRI examinations per 1000 women with breast imaging within the same year and described the clinical indications for the breast MRI examinations by year and age. We compared women screened with breast MRI to women screened with mammography alone for patient characteristics and lifetime breast cancer risk. RESULTS The overall rate of breast MRI from 2005 through 2009 nearly tripled from 4.2 to 11.5 examinations per 1000 women, with the most rapid increase from 2005 to 2007 (P = .02). The most common clinical indication was diagnostic evaluation (40.3%), followed by screening (31.7%). Compared with women who received screening mammography alone, women who underwent screening breast MRI were more likely to be younger than 50 years, white non-Hispanic, and nulliparous and to have a personal history of breast cancer, a family history of breast cancer, and extremely dense breast tissue (all P < .001). The proportion of women screened using breast MRI at high lifetime risk for breast cancer (>20%) increased during the study period from 9% in 2005 to 29% in 2009. CONCLUSIONS AND RELEVANCE Use of breast MRI for screening in high-risk women is increasing. However, our findings suggest that there is a need to improve appropriate use, including among women who may benefit from screening breast MRI.
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Affiliation(s)
| | - Wendy B DeMartini
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
| | | | - Constance D Lehman
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
| | - Tracy Onega
- Department of Community and Family Medicine, Norris Cotton Cancer Center, Dartmouth Medical School, Hanover, New Hampshire
| | - Karla Kerlikowske
- General Internal Medicine Section, Department of Veterans Affairs, San Francisco, California5Department of Medicine, University of California, San Francisco6Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Berta M Geller
- Department of Family Medicine, University of Vermont, Burlington9Department of Radiology, University of Vermont, Burlington
| | - Mike Hofmann
- Department of Medicine, University of California, San Francisco
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Trivers KF, Baldwin LM, Miller JW, Matthews B, Andrilla CHA, Lishner DM, Goff BA. Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians: a vignette-based study. Cancer 2011; 117:5334-43. [PMID: 21792861 DOI: 10.1002/cncr.26166] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/13/2011] [Accepted: 03/04/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Genetic counseling and testing is recommended for women at high but not average risk of ovarian cancer. National estimates of physician adherence to genetic counseling and testing recommendations are lacking. METHODS Using a vignette-based study, we surveyed 3200 United States family physicians, general internists, and obstetrician/gynecologists and received 1878 (62%) responses. The questionnaire included an annual examination vignette asking about genetic counseling and testing. The vignette varied patient age, race, insurance status, and ovarian cancer risk. Estimates of physician adherence to genetic counseling and testing recommendations were weighted to the United States primary care physician population. Multivariable logistic regression identified independent patient and physician predictors of adherence. RESULTS For average-risk women, 71% of physicians self-reported adhering to recommendations against genetic counseling or testing. In multivariable modeling, predictors of adherence against referral/testing included black versus white race (relative risk [RR], 1.16; 95% confidence interval [CI], 1.03-1.31), Medicaid versus private insurance (RR, 1.15; 95% CI, 1.02-1.29), and rural versus urban location. Among high-risk women, 41% of physicians self-reported adhering to recommendations to refer for genetic counseling or testing. Predictors of adherence for referral/testing were younger patient age [35 vs 51 years [RR, 1.78; 95% CI, 1.41-2.24]), physician sex (female vs male [RR, 1.30; 95% CI, 1.07-1.64]), and obstetrician/gynecologist versus family medicine specialty (RR, 1.64; 95% CI, 1.31-2.05). For both average-risk and high-risk women, physician-estimated ovarian cancer risk was the most powerful predictor of recommendation adherence. CONCLUSION Physicians reported that they would refer many average-risk women and would not refer many high-risk women for genetic counseling/testing. Intervention efforts, including promotion of accurate risk assessment, are needed.
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Affiliation(s)
- Katrina F Trivers
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Richardson H, Johnston D, Pater J, Goss P. The National Cancer Institute of Canada Clinical Trials Group MAP.3 trial: an international breast cancer prevention trial. ACTA ACUST UNITED AC 2010; 14:89-96. [PMID: 17593981 PMCID: PMC1899358 DOI: 10.3747/co.2007.117] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Several large phase iii trials have demonstrated that tamoxifen—and more recently, raloxifene—can effectively reduce the incidence of invasive breast cancer by 50%. However, these selective estrogen receptor modulators can also be associated with several rare, but serious, adverse events. Recently, the third-generation aromatase inhibitors (ais) have demonstrated excellent efficacy in adjuvant breast cancer trials, and they show particular promise in the breast cancer prevention setting. The National Cancer Institute of Canada Clinical Trials Group (ncic ctg) has developed a randomized phase iii study to determine the efficacy of an ai (exemestane) to reduce the incidence of invasive breast cancer in postmenopausal women at an increased risk for developing breast cancer. The ncic ctg map.3 (ExCel) trial is a double-blind placebo-controlled multicentre, multinational trial. Based on the known preclinical and clinical profile of the ais, a greater reduction in breast cancer incidence with fewer side effects is hypothesized with this class of agents than with tamoxifen or raloxifene.
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Affiliation(s)
- H. Richardson
- National Cancer Institute of Canada Clinical Trials Group, Queen’s University, Kingston, Ontario
| | - D. Johnston
- National Cancer Institute of Canada Clinical Trials Group, Queen’s University, Kingston, Ontario
| | - J. Pater
- National Cancer Institute of Canada Clinical Trials Group, Queen’s University, Kingston, Ontario
| | - P. Goss
- Harvard Medical School, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, U.S.A
- Correspondence to: Paul Goss, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Lawrence House, LRH-302, Boston, Massachusetts 02114 U.S.A. E-mail:
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Abstract
BACKGROUND Physicians who provide primary care to women have the opportunity to identify patients at high risk for breast cancer who are candidates for risk reduction strategies. Our objective was to determine the prevalence and determinants of the adoption of breast cancer risk assessment by primary care physicians. METHODS A cross-sectional survey of a nationally representative random sample of 351 internists, family practitioners, and obstetricians-gynecologists. We used a questionnaire that assessed knowledge, attitudes, discussion of breast cancer risk, use of software to calculate breast cancer risk, and ordering of BRCA1/2 testing. RESULTS Eighty-eight percent of physicians reported discussing breast cancer risk at least once during the previous 12 months; 48% had ordered or referred a patient for BRCA1/2 testing; and 18% had used a software program to calculate breast cancer risk. Physicians who had used BRCA1/2 testing or discussed breast cancer risk factors were more likely to be obstetrician-gynecologists and not in a solo practice; the use of risk software was also more common among obstetrician-gynecologists but was also associated with having a family member with breast cancer and a greater knowledge about breast cancer risk. Having patients ask for risk information was associated with the discussion of risk factors but not with the other risk assessment strategies. CONCLUSIONS Diffusion of breast cancer risk assessment is occurring in primary care practices, with a greater adoption of BRCA1/2 testing than of the use of risk assessment software. Adoption of these strategies seems to be related to the salience of breast cancer personally (for the physician) and within the practice, as well as the size of the practice, rather than attitudes about the risk assessment methods.
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The Impact of Risk Calculation on Treatment Recommendations Made by Glaucoma Specialists in Cases of Ocular Hypertension. J Glaucoma 2008; 17:631-8. [DOI: 10.1097/ijg.0b013e3181659e6a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Masny A, Ropka ME, Peterson C, Fetzer D, Daly MB. Mentoring nurses in familial cancer risk assessment and counseling: lessons learned from a formative evaluation. J Genet Couns 2008; 17:196-207. [PMID: 18224431 DOI: 10.1007/s10897-007-9140-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 11/15/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND As familial cancer genetic services moves into community practice increased numbers of trained health professionals are needed to counsel individuals seeking cancer risk information. Nurses have been targeted to provide cancer risk assessment and counseling. To help prepare nurses for this role, a 5-day training in familial cancer risk assessment and counseling followed by a long-distance mentorship to support continued skill development in the work environment was conducted by Fox Chase Cancer Center, Philadelphia, PA. METHODS Four cohorts (N = 41) have completed the training and were randomized to either an immediate or delayed mentorship. A formative evaluation assessed the nurse's ability to consult with other genetic health professionals and build self-efficacy in counseling skills via responses to questionnaire. A post-mentorship interview evaluated the usefulness, timing and length of the mentorship. RESULTS For both groups, there was a statistically significant improvement in self-efficacy for all skills from baseline to 6 months and an increased number of nurses consulting with genetic health professionals. All the nurses reported the value of the mentorship and those with less cancer risk counseling experience prior to the training needed support and resources for further skill and program development. Lessons learned from this formative evaluation are provided.
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Affiliation(s)
- Agnes Masny
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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Karliner LS, Napoles-Springer A, Kerlikowske K, Haas JS, Gregorich SE, Kaplan CP. Missed opportunities: family history and behavioral risk factors in breast cancer risk assessment among a multiethnic group of women. J Gen Intern Med 2007; 22:308-14. [PMID: 17356960 PMCID: PMC1824768 DOI: 10.1007/s11606-006-0087-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Clinician's knowledge of a woman's cancer family history (CFH) and counseling about health-related behaviors (HRB) is necessary for appropriate breast cancer care. OBJECTIVE To evaluate whether clinicians solicit CFH and counsel women on HRB; to assess relationship of well visits and patient risk perception or worry with clinician's behavior. DESIGN Cross-sectional population-based telephone survey. PARTICIPANTS Multiethnic sample; 1,700 women from San Francisco Mammography Registry with a screening mammogram in 2001-2002. PREDICTORS well visit in prior year, self-perception of 10-year breast cancer risk, worry scale. OUTCOMES Patient report of clinician asking about CFH in prior year, or ever counseling about HRB in relation to breast cancer risk. Multivariate models included age, ethnicity, education, language of interview, insurance/mammography facility, well visit, ever having a breast biopsy/follow-up mammography, Gail-Model risk, Jewish heritage, and body mass index. RESULTS 58% reported clinicians asked about CFH; 33% reported clinicians ever discussed HRB. In multivariate analysis, regardless of actual risk, perceived risk, or level of worry, having had a well visit in prior year was associated with increased odds (OR = 2.3; 95% CI 1.6, 3.3) that a clinician asked about CFH. Regardless of actual risk of breast cancer, a higher level of worry (OR = 1.9; 95% CI 1.4, 2.6) was associated with increased odds that a clinician ever discussed HRB. CONCLUSIONS Clinicians are missing opportunities to elicit family cancer histories and counsel about health-related behaviors and breast cancer risk. Preventive health visits offer opportunities for clinicians to address family history, risk behaviors, and patients' worries about breast cancer.
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Affiliation(s)
- Leah S. Karliner
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California USA
| | - Anna Napoles-Springer
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California USA
- UCSF Comprehensive Cancer Center, University of California, San Francisco, California USA
| | - Karla Kerlikowske
- General Internal Medicine Section, Department of Veterans’ Affairs, University of California, San Francisco, California USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
- Department of Medicine, University of California, San Francisco, California USA
| | - Jennifer S. Haas
- Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts USA
| | - Steven E. Gregorich
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California USA
| | - Celia Patricia Kaplan
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California USA
- UCSF Comprehensive Cancer Center, University of California, San Francisco, California USA
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Sabatino SA, McCarthy EP, Phillips RS, Burns RB. Breast cancer risk assessment and management in primary care: Provider attitudes, practices, and barriers. ACTA ACUST UNITED AC 2007; 31:375-83. [DOI: 10.1016/j.cdp.2007.08.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2007] [Indexed: 10/22/2022]
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Salant T, Ganschow PS, Olopade OI, Lauderdale DS. "Why take it if you don't have anything?" breast cancer risk perceptions and prevention choices at a public hospital. J Gen Intern Med 2006; 21:779-85. [PMID: 16808782 PMCID: PMC1924720 DOI: 10.1111/j.1525-1497.2006.00461.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Despite advances in breast cancer risk assessment and risk reduction technologies, little is still known about how high-risk women make sense of their risk and assess prevention options, particularly among minority and low-income women. Qualitative methods explore the complex meanings and logics of risk and prevention that quantitative approaches overlook. OBJECTIVE This study examined how women attending a high risk breast cancer clinic at a public hospital conceptualize their breast cancer risk and think about the prevention options available to them. METHODS Semi-structured interviews were used to gather data from 33 high-risk women (75% African American) between May and August 2004. Interview transcripts were analyzed for recurrent themes and patterns. RESULTS Despite general awareness of their objective risk status, many women in this study reported they did not feel "high risk" because they lacked signs and symptoms of cancer. Risk was described as an experienced acute problem rather than a statistical possibility. Women also frequently stated that thinking about cancer might cause it to happen and so it is better not to "dwell on it." While screening was welcomed, women were generally skeptical about primary prevention. In particular, preventive therapies were perceived to cause problems and were only acceptable as treatment options for a disease. CONCLUSIONS The body of ideas about risk and prevention expressed by this population differ from the medical model. These findings have implications for risk perception research as well as for the efficacy of risk communication and prevention counseling in clinical contexts.
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Affiliation(s)
- Talya Salant
- Pritzker Medical School and History of Culture, University of Chicago, Chicago, IL 60637, USA
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Heisey R, Pimlott N, Clemons M, Cummings S, Drummond N. Women's views on chemoprevention of breast cancer: qualitative study. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2006; 52:624-5. [PMID: 17327893 PMCID: PMC1531726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To determine, in a family practice setting, women's views on incentives for and barriers to taking chemopreventive therapy for breast cancer. DESIGN Descriptive, qualitative study using in-depth semistructured interviews. SETTING Women's College Family Practice Health Centre, an academic centre in Toronto, Ont. PARTICIPANTS THREE GROUPS OF WOMEN WERE RECRUITED: women who might in future be candidates for chemoprevention, women who were then candidates for chemoprevention, and then-current participants in the Study of Tamoxifen and Raloxifene (STAR) chemoprevention trial. METHOD Women were asked about their views on taking a pill to prevent breast cancer, their hopes and expectations regarding chemoprevention, incentives for and barriers to accepting chemopreventive therapy, and their preferred sources of information. Visual analogue scales were used to estimate perceived risk of breast cancer and personal interest in chemoprevention. Participants' Gail scores, perceptions of risk of breast cancer, perceptions of likelihood of accepting chemopreventive treatment, attitudes, views, and experiences were recorded. MAIN FINDINGS The 27 women interviewed (median age 61 years, range 38 to 77) had a mean Gail score of 3.3 (indicating a 3.3% estimated risk of breast cancer within the next 5 years), range 1.4 to 6.8. Women were very interested in chemoprevention (62% to 67% likelihood of their taking it in the next 5 years). Perceived risk of breast cancer was not correlated with actual risk or with likelihood of taking chemopreventive therapy. To accept chemoprevention, women needed to know it would lead to an acceptable decrease in risk of breast cancer and needed more information about the medication. Incentives for acceptance included clear evidence of efficacy, prevention of cancer, altruism (contributing to an important area of research), secondary gain, and the feeling of being proactive and in control. Barriers included fear of side effects, lack of information, denial, aversion to medication, the term "chemoprevention," and the effect of the "HRT fiasco." Women's most trusted information source was their family physicians. Women overestimated their risk of breast cancer. CONCLUSION Women were interested in chemoprevention, but required more information, preferably from their family physicians. Our data suggest that at least 4 conditions must be met for women to accept chemopreventive therapy. They must believe in its effectiveness, be proactive about their health care, believe side effects will be tolerable, and be able to overcome the fear of ingesting a pill. To make the therapy more acceptable, the term "chemoprevention" should be discontinued.
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Affiliation(s)
- R Heisey
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada.
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Sabatino SA, Burns RB, Davis RB, Phillips RS, McCarthy EP. Breast cancer risk and provider recommendation for mammography among recently unscreened women in the United States. J Gen Intern Med 2006; 21:285-91. [PMID: 16686802 PMCID: PMC1484729 DOI: 10.1111/j.1525-1497.2006.00348.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Many women with increased breast cancer risk have not been screened recently. Provider recommendation for mammography is an important reason many women undergo screening. We examined the association between breast cancer risk and reported provider recommendation for mammography in recently unscreened women. DESIGN Cross-sectional study using 2000 National Health Interview Survey. PARTICIPANTS In all, 1673 women ages 40 to 75 years without cancer who saw a health care provider in the prior year and had no mammogram within 2 years. MEASUREMENTS AND ANALYSIS We assessed breast cancer risk by Gail score and risk factors. We used multivariable logistic regression models in SUDAAN adjusted for age, race and illness burden, to examine the association between risk and reported recommendation for mammography within 1 year for all women and women ages 50 to 75 years. RESULTS Of 1673 recently unscreened women, 29% reported a recommendation. Twelve percent of women had increased Gail risk and of these recently unscreened, high-risk women, 25% reported a recommendation. After adjustment, high-risk women were not more likely to report a recommendation than average-risk women. Results were similar for women 50 to 75 years old. No individual breast cancer factors other than age were associated with reporting a recommendation. CONCLUSIONS Approximately 70% of recently unscreened women seen by a health care provider in the prior year reported no recommendation for mammography, regardless of breast cancer risk. This did not include women who received a recommendation and were screened. Increasing reported recommendation rates may represent an opportunity to increase screening participation among recently unscreened women, particularly for women with increased breast cancer risk.
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Affiliation(s)
- Susan A Sabatino
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Skinner CS, Rawl SM, Moser BK, Buchanan AH, Scott LL, Champion VL, Schildkraut JM, Parmigiani G, Clark S, Lobach DF, Bastian LA. Impact of the Cancer Risk Intake System on patient-clinician discussions of tamoxifen, genetic counseling, and colonoscopy. J Gen Intern Med 2005; 20:360-5. [PMID: 15857495 PMCID: PMC1490091 DOI: 10.1111/j.1525-1497.2005.40115.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Cancer Risk Intake System (CRIS), a computerized program that "matches" objective cancer risks to appropriate risk management recommendations, was designed to facilitate patient-clinician discussion. We evaluated CRIS in primary care settings via a single-group, self-report, pretest-posttest design. Participants completed baseline telephone surveys, used CRIS during clinic visits, and completed follow-up surveys 1 to 2 months postvisit. Compared with proportions reporting having had discussions at baseline, significantly greater proportions of participants reported having discussed tamoxifen, genetic counseling, and colonoscopy, as appropriate, after using CRIS. Most (79%) reported CRIS had "caused" their discussion. CRIS is an easily used, disseminable program that showed promising results in primary care settings.
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Wideroff L, Vadaparampil ST, Greene MH, Taplin S, Olson L, Freedman AN. Hereditary breast/ovarian and colorectal cancer genetics knowledge in a national sample of US physicians. J Med Genet 2005; 42:749-55. [PMID: 15784723 PMCID: PMC1735923 DOI: 10.1136/jmg.2004.030296] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Clinically relevant genetics knowledge is essential for appropriate assessment and management of inherited cancer risk, and for effective communication with patients. This national physician survey assessed knowledge regarding basic cancer genetics concepts early in the process of introduction of predictive genetic testing for breast/ovarian and hereditary non-polyposis colorectal cancer (HNPCC) syndromes. METHODS A stratified random sample was selected from the American Medical Association Masterfile of all licensed physicians. In total, 1251 physicians (820 in primary care, 431 in selected subspecialties) responded to a 15 minute questionnaire (response rate 71%) in 1999-2000. Multivariate logistic regression analyses were conducted to identify demographic and practice characteristics associated with accurate response to three knowledge questions. RESULTS Of the study population, 37.5% was aware of paternal inheritance of BRCA1/2 mutations, and 33.8% recognised that these mutations occur in <10% of breast cancer patients. Only 13.1% accurately identified HNPCC gene penetrance as >or=50%. Obstetrics/gynaecology physicians, oncologists, and general surgeons were significantly more likely than general and family practitioners to respond accurately to the breast/ovarian questions, as were gastroenterologists to the HNPCC question. CONCLUSIONS These nationally representative data indicate limited physician knowledge about key cancer genetics concepts in 1999-2000, particularly among general primary care physicians. Specialists were more knowledgeable about syndromes they might treat or refer elsewhere. Recent dissemination of practice guidelines and continued expansion of relevant clinical literature may enhance knowledge over time. In addition to educational efforts to assist physicians with the growing knowledge base, more research is needed to characterise the organisational changes required within the healthcare system to provide effective cancer genetics services.
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Affiliation(s)
- L Wideroff
- Applied Research Program/Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7344, USA.
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