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Show Breast Cancer Screening Practices and Information Sources of Utah Physicians Brandan A Hull, M.D., Stephen Ratcliffe, M.D., M.S.P.H., Mary Bishop Stone, M.B.A. Abstract The sources of information on which physicians rely to determine their recommendations for breast cancer screening are numerous; however, the ones that shape their practices are unknown. Of 947 primary care physicians practicing in Utah in the spring of 2000, 367 completed a one page survey detailing breast cancer screening practices and sources of information used to formulate those practices. The most frequently cited sources of information influencing screening practices were published recommendations, personal experience and personal literature review. The least frequently cited sources were local expert and health maintenance organization (HMO) recommendations. Screening practices are summarized for all respondents and for those who cited a published recommendation as the most important source of information. Physicians state that they rely on numerous sources to formulate their screening practices for breast cancer, but reported screening practices tend to follow recommendations of the American Cancer Society and the American College of Obstetricians and Gynecologists even if physicians cite other published guidelines. Controversies abound in the literature for breast cancer screening. Although screening for breast cancer is generally regarded to decrease mortality, its benefit varies in different age groups and with the different screening tests of mammography, clinical breast exam (CBE) and breast self exam (BSE). Mammography refers to radiographic images of the breasts, CBE is physical examination of the breasts by a physician, and BSE is physical examination of the breasts by the patient. Multiple trials have demonstrated a relative risk reduction of 20-30% in women aged 50-69 who were screened using mammography with or without a CBE (Fletcher et al., 1993; Kerlikowske et al., 1995), although a recent meta-analysis found no benefit when inappropriately randomized trials were excluded (Gotzsche & Olsen, 2000). In women younger than age 50, recent evidence supports screening whereas earlier data did not (Kerlikowske et al., 1995; Hendrick et al., 1997; Glasziou et al., 1995). Most studies have not enrolled women older than 74 years old, so the data for benefit in older women are equivocal (Turner et al., 1999). The optimal interval between screening tests has not been determined because studies have produced conflicting results (Kerlikowske et al., 1995; Michaelson et al., 2000). Reflecting the disparate results in the literature, multiple groups have developed recommendations, with differences for each screening test in all of the areas mentioned above: start age, stop age and screening interval (see Table 1). These groups include governmental agencies, private advocacy groups and physician specialty societies. The American Academy of Family Physicians (AAFP), the specialty society of family physicians, updated its 1996 recommendations in July 2000 and again in December 2001 (2001). The American Cancer Society (ACS) updated its 1993 guidelines in 1997 and again in early 2000 (2000). The American College of Obstetricians & Gynecologists (ACOG), the specialty society of obstetrician-gynecologists, updated its 1993 committee opinion in 1997 and again in December 2000 (2000). The American College of Physicians (ACP), the specialty society of internists, published its recommendations in 1989, and an unpublished 1996 update was cited in the United States Preventive Services Task Force's Guide to Clinical Preventive Services, but this update was never published (1989). The American College of Preventive Medicine (ACPM) published its policy statement in 1996 (1996). The American College of Radiology (ACR) published its guidelines in July 1998, and in 28 Utah's Health: An Annual Review Volume VIII |