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Show hand-write the single most important factor that influenced their screening practices (Appendix, question 6 of questionnaire). These written answers corroborated the rated ones. One hundred sixty-seven (45.5%) physicians cited published guidelines, 42 (11.4%) cited personal review of the literature, 23 (6.3%) cited personal experience, 19 (5.2%) cited residency or CME training, 11 (3.0%) cited patient preference, 10 (2.7%) cited another physician (colleague or local expert), 7 (1.9%) cited HMO guidelines and 88 (24.0%) did not respond to the question. Screening Practices The screening practices of respondents are summarized in Tables 4-6. While no organization recommends beginning mammography before age 40 in low-risk patients, 14% of physicians stated that they do so, and 63% said they begin before age 40 in high-risk patients. Of the 232 physicians who said they begin mammography before age 40 in high-risk patients, 147 (63.4%) said they begin between ages 35-39, 68 (29.3%) said they begin between ages 30-34 and 17 (7.3%) said they begin between ages 20-29. Forty-eight (13.2%) physicians stated they vary the interval of screening mammography by age, while 315 (86.8%) recommend constant intervals regardless of the patient's age. Physicians tended to begin screening earlier in high-risk patients, but did not tend to stop later than in low-risk patients. Half of physicians said they increase the frequency of mammography in high-risk patients. Thirty-three (9.0%) physicians said they begin mammography in high-risk patients depending on the age at which the patient's relative was diagnosed with breast cancer, with female physicians more likely than males to follow this practice (p=0.007). The majority of physicians said they begin CBE and BSE in high-risk patients at the same age, stop at the same age and screen with the same frequency as in low-risk patients. One family physician did not recommend mammography; another family physician did not recommend CBE; another family physician, one internist and one obstetrician-gynecologist did not recommend BSE. One family physician referred high-risk patients for screening. Stratified analysis was performed to identify differences by physician specialty and sex (results not tabulated). Obstetrician-gynecologists were more likely than internists or family physicians to begin mammography at age 40-49 in low-risk patients (p<0.003) and to stop later or not at all regardless of patient risk status (p<0.004). In patients ages 40-49, female physicians were more likely than males to recommend mammography (p=0.02). While the majority of all specialties said they begin CBE between ages 18-29, obstetrician-gynecologists were more likely to start earlier (p<0.03) and internists were more likely to start later (p<0.0001), with family physicians in between. Female physicians tended to begin CBE earlier than males (p=0.002). Obstetrician-gynecologists were more likely than family physicians or internists (p<0.003), and female physicians were more likely than males (p=0.005), to stop later or not at all. Internists tended to begin BSE later than family physicians and obstetrician-gynecologists (p<0.007). Male physicians tended to begin later than female physicians in high-risk patients (p=0.0006). With respect to screening interval, the design of the questionnaire allowed respondents to write in their screening practices; responses included "1 year," "2 years," and "1-2 years." National societies recognize a difference between these intervals. In 1997 the American College of Radiology (1998) and the American Cancer Society (2000), and in 1999 the American Medical Association (2001) changed their recommendations for screening mammography in women ages 40-49 from every 1-2 years to every year, beginning at age 40. Conversely, in 1998 the Canadian Task Force on the Periodic Health Examination (2001) changed their recommendation from every year to every 1-2 years. Given these considerations, we chose to treat the screening interval "1-2 years" as a different category than "1 year" or "2 years," although it is not clear that this category carries the same meaning for all who use it. Comparing Information Sources to Screening Practices We desired to compare the reported practice pattern of physicians to the recommendations of the source they considered most important. However, some physicians provided inconsistent responses. In these cases we used the following methodology. If a physician wrote a single source in question 6 of the questionnaire, we considered that source to be most important, irrespective of which sources the physician had rated using the 7-point scale. If a physician wrote more than one source, we considered the first of these to be most important. Utah's Health: An Annual Review Volume VIII 35 |