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Show To be clear, the aim of this study was not to characterize the actual practices of physicians but to characterize the screening model a physician has in mind when counseling patients. Nevertheless, while numerous studies have shown that actual screening practices are far below physicians' intentions to screen, only further questioning and chart reviews of the physicians in this study would elucidate whether their screening model remains the same over time. 3. Physicians probably do not rely on a single recommendation to determine their practices. In fact, most respondents marked multiple sources. Physicians who rated a single recommendation highest were included in the comparison analysis; but even many of these physicians also rated other recommendations high, just not as high. Physicians who rated more than one recommendation equally high may choose one component of screening from one recommendation (e.g. start age from ACS) and another component from another organization (e.g. interval from ACOG). This distinction could not be made with the level of detail provided on the survey. 4. Physicians who cited USPSTF may not necessarily follow that recommendation. Although USPSTF was the second most cited source by those who rated a single recommendation highest, USPSTF summarizes other recommendations and physicians may have adopted recommendations of other organizations while citing USPSTF as their source. Future Research Future research should address the following questions: Why do physicians choose the sources they do? What characteristics of a recommendation make it more likely to affect screening practices? What characteristics of the way in which a recommendation is disseminated to physicians (eg., journal articles, websites, press releases, compendia, letters to physicians) make it more likely to affect screening practices? To what extent does patient input dictate the resulting screening regimen for that patient? Future studies will also provide insight into the controversies of when to start, when to stop, and with what frequency to screen. Conclusion In conclusion, physicians rely on numerous resources besides published guidelines to determine their breast cancer screening practices, but published guidelines are among the most important. When differences exist obstetrician-gynecologists and female physicians tend to screen more aggressively than their counterparts. Some physicians within a given specialty follow the recommendations of their specialty society. However, while a few trends indicate otherwise, even those physicians who cite published recommendations as their most important source of information do not tend to follow the recommendation, and rather gravitate toward a common pattern similar to recommendations by the American Cancer Society and the American College of Obstetricians & Gynecologists. Note: Following acceptance of this study for publication, several recommendation updates were announced. In January 2002 the National Cancer Institute (2002) reaffirmed its recommendations for mammography every 1-2 years beginning at age 40. In February 2002 the United States Preventive Services Task Force (2002) changed its recommendation to screen using mammography with or without clinical breast exam every 1-2 years beginning at age 40, not 50. Special thanks to Tamara Lewis, M.D., M.P.A.., M.P.H. for providing the insight that led to this study. This study was funded by the Health Studies Fund of the Department of Family and Preventive Medicine at the University of Utah School of Medicine. References 1. American Academy of Family Physicians (2001). Summary of policy recommendations for periodic health examinations. November 1996, Revision 5.1, December 2001. (Reprint No. 510). [Online] http://www.aafp.org/exam/. Retrieved 11/21/01. 2. American Cancer Society guidelines for the early detection of breast cancer (2000). CA Cancer JClin, 50: 34-49. 3. American College of Obstetricians and Gynecologists (2000). ACOG Committee Opinion, no. 246. Primary and preventive care: periodic assessments. Washington. DC: American College of Obstetricians and Gynecologists. 4. American College of Physicians (1989). Screening for breast cancer. Ann Intern Med, 111: 389-399. [Online] http://www.acponline. org/sci-policy/guidelines/past.htm/. Retrieved 11/21/01. 5. American College of Preventive Medicine (1996). Screening mammography for breast cancer. Am J Prev Med, 12: 340-341. 6. American College of Radiology. (1998). Guidelines for breast cancer screening. AJR Am J Roentgenol, 171: 29-33. [Online] http:// 38 Utah's Health: An Annual Review Volume VIII |
