Diffusion of Breast Cancer Risk Assessment in Primary Care

Carmen E. Guerra; Melani Sherman; Katrina Armstrong

doi:10.3122/jabfm.2009.03.080153

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Table 1.

Physician and Practice Characteristics and Use of Methods of Breast Cancer Risk Assessment Strategies During Previous 12 Months

Characteristics	Overall (n [%])	Discussed Breast Cancer Risk Factors		P	Used Software to Calculate Breast Cancer Risk		P	Ordered or Referred for BRCA1/2 Testing		P
Characteristics	Overall (n [%])	Yes (n = 312 [88%])	No (n = 39 [12%])	P	Yes (n = 63 [18%])	No (n = 288 [82%])	P	Yes (n = 168 [48%])	No (n = 182 [52%])	P
Physician
Age (mean [SD])	45.6 (11.7)	45.5 (11.4)	45.5 (13.7)	.99	46.1 (11.0)	45.3 (11.8)	.63	46.0 (11.8)	44.9 (11.5)	.14
Male	240 (68)	207 (66)	31 (80)	.10	63 (46)	288 (45)	.20	112 (67)	126 (69)	.64
Specialty				.08			<.01			.01
Family medicine	144 (41)	132 (42)	12 (31)		17 (27)	127 (44)		66 (39)	78 (43)
Internal medicine	140 (39)	118 (38)	22 (56)		17 (27)	123 (43)		59 (35)	80 (44)
Obstetrics/Gynecology	67 (19)	62 (20)	5 (13)		29 (46)	38 (13)		43 (26)	24 (13)
Years since medical school graduation (mean [SD])	17.2 (12.0)	17.1 (11.7)	17.1 (13.9)	.99	19.1 (11.7)	16.7 (12.0)	.15	17.6 (12.0)	16.6 (11.9)	.41
Affiliated with medical school	160 (48)	140 (47)	20 (56)	.33	33 (55)	127 (46)	.22	81 (48)	79 (43)	.21
Family member with breast cancer	42 (12)	39 (13)	3 (8)	.38	13 (22)	29 (10)	.01	23 (14)	19 (10)	.35
Practice
Number of other PCPs in practice				<.01			.55			.06
0	16 (5)	10 (4)	6 (19)		1 (2)	15 (6)		4 (3)	12 (8)
1	57 (18)	53 (19)	4 (13)		8 (14)	48 (19)		82 (54)	74 (47)
2–5	100 (32)	98 (35)	2 (7)		20 (36)	80 (32)		33 (22)	31 (31)
6–10	64 (21)	56 (20)	8 (26)		11 (20)	53 (21)		12 (8)	6 (4)
≥11	73 (24)	63 (23)	10 (32)		16 (29)	57 (22)		20 (13)	35 (21)
Proportion of patients covered by managed care plans				.20			.28			.10
<25%	63 (23)	53 (22)	10 (39)		11 (21)	52 (24)		31 (18)	32 (24)
25–49%	62 (23)	59 (24)	3 (12)		8 (15)	54 (25)		35 (21)	27 (25)
50–74%	96 (36)	88 (36)	8 (31)		20 (39)	76 (35)		51 (30)	45 (32)
75–100%	48 (18)	43 (18)	5 (19)		13 (25)	35 (16)		22 (13)	26 (19)
Patients per week (average n)				.04			.08			.04
<75	116 (35)	95 (33)	21 (62)		15 (25)	101 (37)		45 (27)	71 (39)
75–99	81 (24)	78 (26)	3 (9)		15 (25)	66 (24)		41 (24)	40 (22)
100–139	107 (32)	98 (33)	9 (27)		27 (45)	80 (30)		63 (38)	44 (24)
≥140	28 (8)	27 (9)	1 (3)		3 (5)	25 (9)		11 (7)	7 (9)

PCP, primary care physican.

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Table 2.

Physician Knowledge, Attitudes,* and Use of Methods of Breast Cancer Risk Assessment Strategies During Previous 12 Months

	Overall N (%)	Discussed Breast Cancer Risk Factors		P	Used Software to Calculate Breast Cancer Risk		P	Ordered or Referred for BRCA1/2 Testing		P
	Overall N (%)	Yes (n = 312 [88%])	No (n = 39 [12%])	P	Yes (n = 63 [18%])	No (n = 288 [82%])	P	Yes (n = 168 [48%])	No (n = 182 [57%])	P
Mean knowledge score (SD)^†	0.63 (0.24)	0.63 (0.26)	0.63 (0.22)	.10	0.71 (0.25)	0.65 (0.26)	<.01	0.65 (0.27)	0.61 (0.26)	.20
Many patients ask for risk information	124 (35)	121 (39)	1 (3)	<.01	17 (27)	105 (37)	.15	65 (39)	57 (31)	.20
Information about risk creates unnecessary anxiety for many women	48 (14)	43 (14)	5 (13)	.39	9 (14)	39 (14)	.98	27 (16)	21 (12)	.21
Available methods of predicting risk are not accurate enough	46 (13)	44 (14)	2 (5)	.09	9 (14)	37 (13)	.53	22 (13)	24 (13)	.99
Too time consuming to evaluate and discuss risk	37 (11)	31 (10)	6 (15)	.20	8 (13)	29 (10)	.70	21 (13)	15 (8)	.17
Reluctant to use breast cancer risk assessment because a woman at low risk of breast cancer might decide not to undergo mammography screening	22 (6)	20 (6)	2 (5)	.56	3 (5)	19 (7)	.74	12 (7)	10 (5)	.51

* For attitudes, the table shows the n and proportion of physicians who agree or strongly agree with the attitude statement.
† Mean knowledge score is the mean of the proportion of correct responses.

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Table 3.

Adjusted Association Between Physician Demographics, Attitudes, Knowledge, and Use of Methods of Breast Cancer Risk Assessment*

	Discussed Breast Cancer Risk Factors	Used Software to Calculate Breast Cancer Risk	Ordered or Referred for BRCA1/2 Testing
Specialty
Internal medicine (ref)	1.00	1.00	1.00
Family practice	1.47 (0.58–3.71)	0.83 (0.37–1.81)	0.95 (0.57–1.59)
Obstetrics/gynecology	3.35 (1.01–11.13)	5.37 (2.49–11.55)	2.36 (1.24–4.49)
Solo practice	0.14 (0.04–0.56)	0.16 (0.02–1.36)	0.27 (0.07–0.96)
Family member with breast cancer	1.63 (0.41–6.39)	2.76 (1.27–5.30)	1.19 (0.59–2.47)
Attitudes
Many patients ask for information about their risk of breast cancer	24.60 (3.44–195.82)	0.83 (0.42–1.61)	1.52 (0.95–2.44)
Knowledge
Accuracy score (one point increase)	1.23 (0.26–5.69)	4.57 (1.17–17.08)	1.82 (0.73–4.55)

* Models include all the variables in the table as well as physician age, sex, and number of patients seen per week.
All data provided as odds ratio (95% CI).