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Hindmarch S, Gorman L, Hawkes RE, Howell SJ, French DP. "I don't know what I'm feeling for": young women's beliefs about breast cancer risk and experiences of breast awareness. BMC Womens Health 2023; 23:312. [PMID: 37328760 PMCID: PMC10276361 DOI: 10.1186/s12905-023-02441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/17/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Younger women are often diagnosed with advanced breast cancer. Beliefs about risk are instrumental in motivating many health protective behaviours, but there may be confusion around which behaviour is appropriate to detect breast cancer earlier. Breast awareness, defined as an understanding of how the breasts look and feel so changes can be identified early, is widely recommended. In contrast, breast self-examination involves palpation using a specified method. We aimed to investigate young women's beliefs about their risk and experiences of breast awareness. METHODS Thirty-seven women aged 30-39 years residing in a North West region of England with no family or personal history of breast cancer participated in seven focus groups (n = 29) and eight individual interviews. Data were analysed using reflexive thematic analysis. RESULTS Three themes were generated. "Future me's problem" describes why women perceive breast cancer as an older woman's disease. Uncertainty regarding checking behaviours highlights how confusion about self-checking behaviour advice has resulted in women infrequently performing breast checks. Campaigns as a missed opportunity highlights the potential negative effects of current breast cancer fundraising campaigns and the perceived absence of educational campaigning about breast cancer for this demographic. CONCLUSIONS Young women expressed low perceived susceptibility to developing breast cancer in the near future. Women did not know what breast self-checking behaviours they should be performing and expressed a lack of confidence in how to perform a breast check appropriately due to limited knowledge about what to look and feel for. Consequently, women reported disengagement with breast awareness. Defining and clearly communicating the best strategy for breast awareness and establishing whether it is beneficial or not are essential next steps.
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Affiliation(s)
- Sarah Hindmarch
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Louise Gorman
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rhiannon E Hawkes
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sacha J Howell
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - David P French
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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2
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James JE, Joseph G. "It's personalized, but it's still bucket based": The promise of personalized medicine vs. the reality of genomic risk stratification in a breast cancer screening trial. NEW GENETICS AND SOCIETY 2022; 41:228-253. [PMID: 36936188 PMCID: PMC10021681 DOI: 10.1080/14636778.2022.2115348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Adaptive pragmatic clinical trials offer an innovative approach that integrates clinical care and research. Yet, blurring the boundaries between research and clinical care raises questions about how clinicians and investigators balance their caregiving and research roles and what types of knowledge and risk assessment are most valued. This paper presents findings from an ethnographic ELSI (Ethical, Legal, Social Implications) study of an innovative clinical trial of risk-based breast cancer screening that utilizes genomics to stratify risk and recommend a breast cancer screening commensurate with the assessed risk. We argue that the trial demonstrates a fundamental tension between the promissory ideals of personalized medicine, and the reality of implementing risk stratified care on a population scale. We examine the development of a Screening Assignment Review Board in response to this tension which allows clinician-investigators to negotiate, but never fully resolve, the inherent contradiction of 'precision population screening'.
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Affiliation(s)
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco
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3
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Edmonds CE, Zuckerman SP, Guerra CE. Racial Disparities Persist in Cancer Screening: New USPSTF Colorectal Cancer Screening Guidelines Illuminate Inadequate Breast Cancer Screening Guidelines for Black Women. J Gen Intern Med 2022; 37:1534-1536. [PMID: 35015261 PMCID: PMC9086022 DOI: 10.1007/s11606-021-07368-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Christine E Edmonds
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Samantha P Zuckerman
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Carmen E Guerra
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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4
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Mammography screening and mortality by risk status in the California teachers study. BMC Cancer 2021; 21:1341. [PMID: 34922473 PMCID: PMC8684058 DOI: 10.1186/s12885-021-09071-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
Background The debate continues among medical professionals regarding the frequency, starting age, and stopping age for mammography screening. Some experts suggest tailoring recommendations based on individuals’ personal breast cancer risk. Previous studies have not compared the impact of annual versus biennial mammography stratified by age group and risk category. The purpose of this study was to examine the relationship between mammography frequency and mortality by age group and risk category in the California Teachers Study. Methods Using data from study questionnaires from 93,438 women between the ages of 40 and 85 and linkages to the California Cancer Registry and other indices, overall and breast cancer-specific mortality by mammography frequency were estimated using multivariable Cox proportional hazards models, stratified by age group and risk category at baseline as determined by the Gail breast cancer risk model. Results During the follow-up period of 20 years, overall mortality risk was lower in women who had annual or biennial mammography compared to less frequent or no mammography in all age groups. Annual mammography was associated with lower overall mortality risk compared to biennial mammography among women age 50–85. This difference was especially apparent in women age 60–74, regardless of estimated Gail risk category at baseline. Breast cancer-specific mortality was lower among women who had annual mammography compared to biennial or less frequent mammography among women age 60–74, regardless of their baseline risk. Conclusions Our findings suggest that at least biennial mammography is beneficial to most women age 40–85 and that annual mammography is more beneficial than biennial mammography to most women age 50–85 in terms of overall mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09071-1.
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5
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Manning M, O'Neill S, Purrington K. Physicians' perceptions of breast density notification laws and appropriate patient follow-up. Breast J 2021; 27:586-594. [PMID: 33991030 DOI: 10.1111/tbj.14240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/19/2022]
Abstract
Breast density notification laws have been adopted in the absence of consistent guidelines for post-notification follow-up. This can lead to inconsistent and potentially deficient management of women's health due to inconsistent physician practices. We examined physicians' knowledge and practices regarding follow-up for patients who receive density notifications. Physicians who referred patients to a Michigan hospital network for screening mammograms were recruited to participate in survey study; 105 (29.8%) responded. The survey assessed physicians' demographics, knowledge, and awareness of breast density and breast cancer risk and of density notification laws, and perceptions of appropriate follow-up behaviors for their patients who received density notifications. Most physicians (75%) knew about the notification law, and they were generally comfortable responding to breast density questions and deciding on follow-up. Most indicated that additional breast imaging (68.0%), followed by assessing breast cancer risk (24.7%) were appropriate follow-up responses. Physicians who performed breast cancer risk assessments, and who were more comfortable with breast density questions and follow-up decision making, were more likely to propose additional imaging. Male physicians were less likely to propose assessing breast cancer risk, and less likely to propose clinical and/or breast self-examinations. Divergence between practice and guidelines when it comes to supplemental breast cancer screening, coupled with density notification language that promotes additional screening in the absence of consistent evidence, remains concerning. Improved understanding of how density notification recipients and their physicians make decisions about supplemental screening is warranted to ensure that breast cancer risk is properly considered.
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Affiliation(s)
- Mark Manning
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Suzanne O'Neill
- Department of Oncology, Lombardi Cancer Center, Georgetown University, Washington, DC, USA
| | - Kristen Purrington
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
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6
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Martin K, Vogel RI, Nagler RH, Wyman JF, Raymond N, Teoh D, Allen AM, Talley KM, Mason S, Blaes AH. Mammography Screening Practices in Average-Risk Women Aged 40-49 Years in Primary Care: A Comparison of Physician and Nonphysician Providers in Minnesota. J Womens Health (Larchmt) 2020; 29:91-99. [PMID: 31314684 PMCID: PMC6983752 DOI: 10.1089/jwh.2018.7436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Breast cancer screening practices and the influence of clinical guidelines or recommendations are well documented for physicians, but little is known about the screening practices of nonphysician providers (physician assistants and advanced practice registered nurses). The seven breast cancer screening guidelines or recommendations on the use of mammography have the most variation for screening average-risk women 40-49 years of age. Therefore, to better understand the practices of nonphysicians, this study will compare the practices of physicians with nonphysician providers for women 40-49 years of age. Materials and Methods: Minnesota physicians and nonphysicians were e-mailed an anonymous cross-sectional survey, which asked primary care providers about their mammography screening practices for average-risk women 40-44 and 45-49 years of age and to rate the influence of seven breast cancer screening recommendations on the use of mammography in their practice. Comparisons across providers' demographic and professional characteristics were conducted using chi-squared and Fisher's exact tests, as appropriate, and multivariate logistic regression analyses. Results: Of the respondents who practiced primary care (193 physicians, 50 physician assistants, and 197 advanced practice registered nurses), 66.7% reported recommending mammography for women at ages 40-44 and 77.2% recommended mammography for women at ages 45-49. Nonphysician providers were more likely to recommend screening in both these age groups (p < 0.05). Having a self-identified interest in women's health was associated with more mammography screening in both age groups. The American Cancer Society guideline was endorsed as influential by the most respondents. Conclusions: Breast cancer screening practices vary between physicians and nonphysician providers for women 40-49 years of age at average risk. Targeted interventions may help reduce practice variation and ensure high-value care.
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Affiliation(s)
- Katherine Martin
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | - Rachel I. Vogel
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota
| | - Rebekah H. Nagler
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, Minnesota
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Jean F. Wyman
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
- Center for Aging Science and Care Innovation, University of Minnesota, Minneapolis, Minnesota
| | - Nancy Raymond
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Deanna Teoh
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota
| | - Alicia M Allen
- College of Medicine, University of Arizona, Tucson, Arizona
| | | | - Susan Mason
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Anne H. Blaes
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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7
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Pelletier S, Larouche G, Chiquette J, El Haffaf Z, Foulkes WD, Hamet P, Simard J, Dorval M. Survey of primary care physicians' views about breast and ovarian cancer screening for true BRCA1/2 non-carriers. J Community Genet 2019; 11:205-213. [PMID: 31659621 DOI: 10.1007/s12687-019-00438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/04/2019] [Indexed: 10/25/2022] Open
Abstract
Despite some controversy, true BRCA1/2 non-carriers are generally considered to be at an average risk for breast and ovarian cancer. Primary care physicians are then expected to encourage their non-carrier patients to adopt cancer screening practices appropriate to women of the same age in the general population. This study aimed to describe breast and ovarian cancer screening recommendations that primary care physicians would consider advisable for young true BRCA1/2 non-carriers. One hundred thirty-four family physicians and 123 gynecologists (response rate 45%) completed a cross-sectional mailed survey administered in the Province of Quebec, Canada. The survey included questions about basic genetic knowledge and screening recommendations for two fictitious cases (< 40 years), one carrier and one non-carrier, from a BRCA1/2 mutation-positive family. Screening exams considered advisable did not differ significantly between family physicians and gynecologists. More than 75% of physicians considered the cancer risks of true non-carriers to be comparable with that of the general population and 14% to be a little higher. Still, 53% would prescribe a biennial and or even an annual (27%) mammography to a non-carrier woman before the recommended starting age. Physician considerations of non-carriers' expectations or requests for screening were associated with more screening prescriptions. More than half of primary care physicians would recommend more mammography screenings than expected for a young true BRCA1/2 non-carrier. Personalized cancer risk assessment may help primary care physicians tailor screening of women from BRCA1/2 mutation-positive families and allow these women to make more informed choices regarding cancer risk management options.
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Affiliation(s)
- S Pelletier
- Oncology Division, CHU de Québec - Université Laval Research Center, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.,Université Laval Cancer Research Centre, Québec, QC, Canada
| | - G Larouche
- Oncology Division, CHU de Québec - Université Laval Research Center, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.,Université Laval Cancer Research Centre, Québec, QC, Canada
| | - J Chiquette
- Oncology Division, CHU de Québec - Université Laval Research Center, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.,Université Laval Cancer Research Centre, Québec, QC, Canada.,Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Z El Haffaf
- Genetic Medicine Service, Montreal University Hospital (CHUM), Montréal, QC, Canada
| | - W D Foulkes
- Department of Medical Genetics, Jewish General Hospital, Montréal, QC, Canada.,Lady Davis Institute of the Jewish General Hospital, Montréal, QC, Canada.,Departments of Oncology, Human Genetics and Medicine, McGill University, Montréal, QC, Canada
| | - P Hamet
- Research Centre, Montreal University Hospital (CHUM), Montréal, QC, Canada
| | - J Simard
- Oncology Division, CHU de Québec - Université Laval Research Center, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.,Université Laval Cancer Research Centre, Québec, QC, Canada.,Faculty of Medicine, Université Laval, Québec, QC, Canada.,Canada Research Chair in Oncogenetics, Université Laval, Québec, QC, Canada
| | - M Dorval
- Oncology Division, CHU de Québec - Université Laval Research Center, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada. .,Université Laval Cancer Research Centre, Québec, QC, Canada. .,Faculty of Pharmacy, Université Laval, Québec, QC, Canada. .,Research Centre of the CISSS Chaudière-Appalaches, Lévis, QC, Canada.
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8
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Maroongroge S, Yu JB. Medicare Cancer Screening in the Context of Clinical Guidelines: 2000 to 2012. Am J Clin Oncol 2019; 41:339-347. [PMID: 26886947 DOI: 10.1097/coc.0000000000000272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Cancer screening is a ubiquitous and controversial public health issue, particularly in the elderly population. Despite extensive evidence-based guidelines for screening, it is unclear how cancer screening has changed in the Medicare population over time. We characterize trends in cancer screening for the most common cancer types in the Medicare fee-for-service (FFS) program in the context of conflicting guidelines from 2000 to 2012. MATERIALS AND METHODS We performed a descriptive analysis of retrospective claims data from the Medicare FFS program based on billing codes. Our data include all claims for Medicare part B beneficiaries who received breast, colorectal (CRC), or prostate cancer screening from 2000 to 2012 based on billing codes. We utilize a Monte Carlo permutation method to detect changes in screening trends. RESULTS In total, 231,416,732 screening tests were analyzed from 2000 to 2012, representing an average of 436.8 tests per 1000 beneficiaries per year. Mammography rates declined 7.4%, with digital mammography extensively replacing film. CRC cancer screening rates declined overall. As a percentage of all CRC screening tests, colonoscopy grew from 32% to 71%. Prostate screening rates increased 16% from 2000 to 2007, and then declined to 7% less than its 2000 rate by 2012. DISCUSSION Both the aggressiveness of screening guidelines and screening rates for the Medicare FFS population peaked and then declined from 2000 to 2012. However, guideline publications did not consistently precede utilization trend shifts. Technology adoption, practical and financial concerns, and patient preferences may have also contributed to the observed trends. Further research should be performed on the impact of multiple, conflicting guidelines in cancer screening.
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Affiliation(s)
- Sean Maroongroge
- Yale School of Medicine.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
| | - James B Yu
- Yale School of Medicine.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT.,Department of Therapeutic Radiology, Yale School of Medicine
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9
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Radhakrishnan A, Nowak SA, Parker AM, Visvanathan K, Pollack CE. Linking physician attitudes to their breast cancer screening practices: A survey of US primary care providers and gynecologists. Prev Med 2018; 107:90-102. [PMID: 29155227 PMCID: PMC5846094 DOI: 10.1016/j.ypmed.2017.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/02/2017] [Accepted: 11/09/2017] [Indexed: 01/28/2023]
Abstract
Despite changes to breast cancer screening guidelines intended to decrease screening in younger and older women, mammography rates remain high. We investigated physician attitudes towards screening younger and older women. Surveys were mailed to US primary care providers and gynecologists between May and September 2016 (871/1665, 52.3% adjusted response rate). We assessed physician (1) attitudes towards screening younger (45-49years) and older (75+ years) women and (2) recommendations for routine mammography. We used exploratory factor analysis to identify underlying themes among physician attitudes and created measures standardized to a 5-point scale. Using multivariable logistic regression models, we examined associations between physician attitudes and screening recommendations. Attitudes identified with factor analysis included: potential regret, expectations, and discordant guidelines (referred to as potential regret), patient-related hazards due to screening, physician limitations and uncertainty, and concerns about rationing care. Gynecologists had higher levels of potential regret compared to internists. In adjusted analyses, physicians with increasing potential regret (1-point increment on 5-point scale) had higher odds of recommending mammography to younger (OR 8.68; 95% CI 5.25-14.36) and older women (OR 4.62; 95% CI 3.50-6.11). Increasing concern for patient-related hazards was associated with decreased odds of recommending screening to older women (OR 0.68; 95% CI 0.56-0.83). Physicians were more motivated by potential regret in recommending screening for younger and older women than by concerns for patient-related hazards in screening. Addressing physicians' most salient concerns, such as fear of missing cancer diagnoses and malpractice, may present an important opportunity to improving delivery of guideline-concordant cancer screening.
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Affiliation(s)
| | | | | | - Kala Visvanathan
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Epidemiology and Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Craig E Pollack
- Department of Epidemiology and Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, United States
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10
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Wernli KJ, Arao RF, Hubbard RA, Sprague BL, Alford-Teaster J, Haas JS, Henderson L, Hill D, Lee CI, Tosteson ANA, Onega T. Change in Breast Cancer Screening Intervals Since the 2009 USPSTF Guideline. J Womens Health (Larchmt) 2017; 26:820-827. [PMID: 28177856 DOI: 10.1089/jwh.2016.6076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In 2009, the U.S. Preventive Services Task Force (USPSTF) recommended biennial mammography for women aged 50-74 years and shared decision-making for women aged 40-49 years for breast cancer screening. We evaluated changes in mammography screening interval after the 2009 recommendations. MATERIALS AND METHODS We conducted a prospective cohort study of women aged 40-74 years who received 821,052 screening mammograms between 2006 and 2012 using data from the Breast Cancer Surveillance Consortium. We compared changes in screening intervals and stratified intervals based on whether the mammogram at the end of the interval occurred before or after the 2009 recommendation. Differences in mean interval length by woman-level characteristics were compared using linear regression. RESULTS The mean interval (in months) minimally decreased after the 2009 USPSTF recommendations. Among women aged 40-49 years, the mean interval decreased from 17.2 months to 17.1 months (difference -0.16%, 95% confidence interval [CI] -0.30 to -0.01). Similar small reductions were seen for most age groups. The largest change in interval length in the post-USPSTF period was declines among women with a first-degree family history of breast cancer (difference -0.68%, 95% CI -0.82 to -0.54) or a 5-year breast cancer risk ≥2.5% (difference -0.58%, 95% CI -0.73 to -0.44). CONCLUSIONS The 2009 USPSTF recommendation did not lengthen the average mammography interval among women routinely participating in mammography screening. Future studies should evaluate whether breast cancer screening intervals lengthen toward biennial intervals following new national 2016 breast cancer screening recommendations, particularly among women less than 50 years of age.
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Affiliation(s)
- Karen J Wernli
- 1 Group Health Research Institute , Seattle, Washington.,2 Department of Health Services, University of Washington School of Public Health , Seattle, Washington
| | - Robert F Arao
- 1 Group Health Research Institute , Seattle, Washington
| | - Rebecca A Hubbard
- 3 Department of Biostatistics and Epidemiology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Brian L Sprague
- 4 Department of Surgery, Office of Health Promotion Research, and the University of Vermont Cancer Center, University of Vermont , Burlington, Vermont
| | - Jennifer Alford-Teaster
- 5 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine at Dartmouth, Lebanon , New Hampshire.,6 Departments of Biomedical Science and Epidemiology, Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire
| | - Jennifer S Haas
- 7 Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.,8 Harvard School of Public Health, Boston, Massachusetts
| | - Louise Henderson
- 9 Department of Radiology, University of North Carolina , Chapel Hill, North Carolina
| | - Deidre Hill
- 10 University of New Mexico Cancer Center and School of Medicine, Albuquerque, New Mexico
| | - Christoph I Lee
- 2 Department of Health Services, University of Washington School of Public Health , Seattle, Washington.,11 Department of Radiology, University of Washington School of Medicine , Seattle, Washington.,12 Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
| | - Anna N A Tosteson
- 6 Departments of Biomedical Science and Epidemiology, Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire.,13 Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon , New Hampshire
| | - Tracy Onega
- 6 Departments of Biomedical Science and Epidemiology, Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire
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11
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Chang CH, Bynum JPW, Onega T, Colla CH, Lurie JD, Tosteson ANA. Screening Mammography Use Among Older Women Before and After the 2009 U.S. Preventive Services Task Force Recommendations. J Womens Health (Larchmt) 2016; 25:1030-1037. [PMID: 27427790 DOI: 10.1089/jwh.2015.5701] [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: 11/13/2022] Open
Abstract
BACKGROUND It is uncertain how changes in the U.S. Preventive Services Task Force breast cancer screening recommendations (from annual to biennial mammography screening in women aged 50-74 and grading the evidence as insufficient for screening in women aged 75 and older) have affected mammography use among Medicare beneficiaries. MATERIALS AND METHODS Cohort study of 12 million Medicare fee-for-service women aged 65-74 and 75 and older to measure changes in 3-year screening use, 2007-2009 (before) and 2010-2012 (after), defined by two measures-proportion screened and frequency of screening by age, race/ethnicity, and hospital referral region. RESULTS Fewer women were screened, but with similar frequency after 2009 for both age groups (after vs. before: age 65-74: 60.1% vs. 60.8% screened, 2.1 vs. 2.1 mammograms per screened woman; age 75 and older: 31.7% vs. 33.6% screened, 1.9 vs. 1.9 mammograms per screened woman; all p < 0.05). Black women were the only subgroup with an increase in screening use, and for both age groups (after vs. before: age 65-74: 55.4% vs. 54.0% screened and 2.0 vs. 1.9 mammograms per screened woman; age 75 and older: 28.5% vs. 27.9% screened and 1.8 vs. 1.8 mammograms per screened woman; all p < 0.05). Regional change patterns in screening were more similar between age groups (Pearson correlation r = 0.781 for proportion screened; r = 0.840 for frequency of screening) than between black versus nonblack women (Pearson correlation r = 0.221 for proportion screened; r = 0.212 for frequency of screening). CONCLUSIONS Changes in screening mammography use for Medicare women are not fully aligned with the 2009 recommendations.
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Affiliation(s)
- Chiang-Hua Chang
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire
| | - Julie P W Bynum
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.,2 Department of Medicine, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire
| | - Tracy Onega
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.,3 Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire
| | - Carrie H Colla
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.,3 Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire
| | - Jon D Lurie
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.,2 Department of Medicine, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire
| | - Anna N A Tosteson
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.,2 Department of Medicine, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire.,3 Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire
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12
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Are Physicians Influenced by Their Own Specialty Society's Guidelines Regarding Mammography Screening? An Analysis of Nationally Representative Data. AJR Am J Roentgenol 2016; 207:959-964. [PMID: 27504599 DOI: 10.2214/ajr.16.16603] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to determine whether primary care physicians were influenced by their own specialty society's mammography screening recommendations after the 2009 U.S. Preventive Services Task Force's (USPSTF) revised recommendations were released. MATERIALS AND METHODS We performed an analysis of cross-sectional nationally representative data for 2007-2012 from the National Ambulatory Medical Care Survey (NAMCS). All office-based preventive services visits for women 40 years old or older were included. Multivariate regression analyses were used to identify changes over time in the mammography referral rate per 1000 visits by physician specialty, adjusting for patient- and office-level covariates. All analyses were weighted to account for the multistage probability sampling design of NAMCS. RESULTS Our analysis represented an average of 35,947,290 office visits per year. Overall, between 2007-2008 and 2011-2012, mammography referral rates (per 1000 visits) decreased from 285 to 215 referrals (-25.0% adjusted change; p = 0.006). The largest decrease was among family physicians (from 230 to 128; -49.0% adjusted change; p < 0.001), followed by internal medicine physicians (from 135 to 79; -45.8% adjusted change; p = 0.038). No statistically significant change was noted among obstetricians and gynecologists over time (from 476 to 419; -14.4% adjusted change; p = 0.23). DISCUSSION Family and internal medicine physicians, whose societies adhered to 2009 USPSTF recommendations for biennial screening starting at age 50 years, showed statistically significant decreases in mammography referral rates over time. Obstetricians and gynecologists, whose society continued to recommend annual screening starting at age 40 years, showed no statistically significant change in mammography referral rates over time. Physicians may be influenced by their own society's recommendations, which may influence their shared decision-making discussions with patients.
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Sigmund AE, Stevens ER, Blitz J, Ladapo JA. Use of Preoperative Testing and Physicians' Response to Professional Society Guidance. JAMA Intern Med 2015; 175:1352-9. [PMID: 26053956 PMCID: PMC4526021 DOI: 10.1001/jamainternmed.2015.2081] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE The value of routine preoperative testing before most surgical procedures is widely considered to be low. To improve the quality of preoperative care and reduce waste, 2 professional societies released guidance on use of routine preoperative testing in 2002, but researchers and policymakers remain concerned about the health and cost burden of low-value care in the preoperative setting. OBJECTIVE To examine the long-term national effect of the 2002 professional guidance from the American College of Cardiology/American Heart Association and the American Society of Anesthesiologists on physicians' use of routine preoperative testing. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of nationally representative data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to examine adults in the United States who were evaluated during preoperative visits from January 1, 1997, through December 31, 2010. A quasiexperimental, difference-in-difference (DID) approach evaluated whether the publication of professional guidance in 2002 was associated with changes in preoperative testing patterns, adjusting for temporal trends in routine testing, as captured by testing patterns in general medical examinations. MAIN OUTCOMES AND MEASURES Physician orders for outpatient plain radiography, hematocrit, urinalysis, electrocardiogram, and cardiac stress testing. RESULTS During the 14-year period, the average annual number of preoperative visits in the United States increased from 6.8 million in 1997-1999 to 9.8 million in 2002-2004 and 14.3 million in 2008-2010. After accounting for temporal trends in routine testing, we found no statistically significant overall changes in the use of plain radiography (11.3% in 1997-2002 to 9.9% in 2003-2010; DID, -1.0 per 100 visits; 95% CI, -4.1 to 2.2), hematocrit (9.4% in 1997-2002 to 4.1% in 2003-2010; DID, 1.2 per 100 visits; 95% CI, -2.2 to 4.7), urinalysis (12.2% in 1997-2002 to 8.9% in 2003-2010; DID, 2.7 per 100 visits; 95% CI, -1.7 to 7.1), or cardiac stress testing (1.0% in 1997-2002 to 2.0% in 2003-2010; DID, 0.7 per 100 visits; 95% CI, -0.1 to 1.5) after the publication of professional guidance. However, the rate of electrocardiogram testing fell (19.4% in 1997-2002 to 14.3% in 2003-2010; DID, -6.7 per 100 visits; 95% CI, -10.6 to -2.7) in the period after the publication of guidance. CONCLUSIONS AND RELEVANCE The release of the 2002 guidance on routine preoperative testing was associated with a reduced incidence of routine electrocardiogram testing but not of plain radiography, hematocrit, urinalysis, or cardiac stress testing. Because routine preoperative testing is generally considered to provide low incremental value, more concerted efforts to understand physician behavior and remove barriers to guideline adherence may improve health care quality and reduce costs.
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Affiliation(s)
- Alana E. Sigmund
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Elizabeth R. Stevens
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Jeanna Blitz
- Department of Anesthesiology, New York University School of Medicine, New York, NY
| | - Joseph A. Ladapo
- Department of Medicine, New York University School of Medicine, New York, NY
- Department of Population Health, New York University School of Medicine, New York, NY
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Atanasov P, Anderson BL, Cain J, Schulkin J, Dana J. Comparing Physicians Personal Prevention Practices and Their Recommendations to Patients. J Healthc Qual 2015. [DOI: 10.1111/jhq.12042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Hirth JM, Kuo YF, Lin YL, Berenson AB. Regional variation in mammography use among insured women 40-49 years old: impact of a USPSTF guideline change. ACTA ACUST UNITED AC 2015; 3:174-182. [PMID: 26661740 DOI: 10.17265/2328-7136/2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The impact of the US Preventive Services Task Force (USPSTF) recommendation that 40-49 year old women should no longer routinely receive screening mammography in November 2009 in different regions of the US is unknown. METHODS We conducted a retrospective cohort study using medical claims from administrative health records from privately insured 40-59 year old women enrolled between 2005 and 2012 to evaluate biennial screening trends. RESULTS There was a slight decrease in mammography usage among 40-49 year old US women after the 2008-2009 biennial period (p<0.001). There were some regional differences in mammography trends, with the West showing the greatest difference in odds of 40-49 year olds receiving a mammography in 2011-2012 compared to 2008-2009 (OR: 0.93; 95% CI: 0.91-0.94). Although trends for 50-59 year olds mirrored that of 40-49 year olds, the younger age group had a stronger decline in 2009-2010 and 2010-2011. CONCLUSIONS These findings show that USPSTF guideline changes made some differences in mammography usage among 40-49 year olds, but adherence was uneven across regions.
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Affiliation(s)
- Jacqueline M Hirth
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Blvd Rte 0587, Galveston, TX 77555,
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555
| | - Yu-Li Lin
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555
| | - Abbey B Berenson
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Blvd Rte 0587, Galveston, TX 77555
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Harvey SC, Vegesna A, Mass S, Clarke J, Skoufalos A. Understanding patient options, utilization patterns, and burdens associated with breast cancer screening. J Womens Health (Larchmt) 2014; 23 Suppl 1:S3-9. [PMID: 25247383 DOI: 10.1089/jwh.2014.1510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite ongoing awareness, educational campaigns, and advances in technology, breast cancer screening remains a complex topic for women and for the health care system. Lack of consensus among organizations developing screening guidelines has caused confusion for patients and providers. The psychosocial factors related to breast cancer screening are not well understood. The prevailing algorithm for screening results in significant rates of patient recall for further diagnostic imaging or procedures, the majority of which rule out breast cancer rather than confirming it. For women, the consequences of the status quo range from unnecessary stress to additional out-of-pocket expenses to indirect costs that are more difficult to quantify. A more thoughtful approach to breast cancer screening, coupled with a research agenda that recognizes the indirect and intangible costs that women bear, is needed to improve cost and quality outcomes in this area.
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Affiliation(s)
- Susan C Harvey
- 1 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions , Baltimore, Maryland
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Raglan G, Lawrence H, Schulkin J. Obstetrician/Gynecologist Care Considerations: Practice Changes in Disease Management with an Aging Patient Population. WOMENS HEALTH 2014; 10:155-60. [DOI: 10.2217/whe.14.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Demographic changes across the country are leading to an increased proportion of older Americans. This shift will likely lead to changes in the patient population seen by obstetrician/gynecologists, and practices may need to adapt to the needs of older women. This article looks at mental health, sexual health, bone loss, cardiovascular disease and cancer as areas in which obstetrician/gynecologists may experience changes with the increasing age of patients. While this is by no means a comprehensive list of changing areas of practice, it offers a guide for reflecting on the future of obstetrician/gynecologists training, and the importance of considering the needs of older patients in practice.
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Affiliation(s)
- Greta Raglan
- American College of Obstetricians & Gynecologists, Research Department, 409 12th Street Southwest, Washington, DC 20024, USA
| | - Hal Lawrence
- American College of Obstetricians & Gynecologists, Research Department, 409 12th Street Southwest, Washington, DC 20024, USA
| | - Jay Schulkin
- American College of Obstetricians & Gynecologists, Research Department, 409 12th Street Southwest, Washington, DC 20024, USA
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