Primary Care Providers' Beliefs and Recommendations and Use of Screening Mammography by their Patients.
Jennifer S Haas, William E Barlow, Marilyn M Schapira, Charles D MacLean, Carrie N Klabunde, Brian L Sprague, Elisabeth F Beaber, Jane S Chen, Asaf Bitton, Tracy Onega, Kimberly Harris, Anna N A Tosteson, PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium
Author Information
Jennifer S Haas: Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA. jhaas@partners.org.
William E Barlow: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Marilyn M Schapira: University of Pennsylvania and the Philadelphia VA Medical Center, Philadelphia, PA, USA.
Charles D MacLean: University of Vermont, Burlington, VT, USA.
Carrie N Klabunde: Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA.
Brian L Sprague: University of Vermont, Burlington, VT, USA.
Elisabeth F Beaber: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Jane S Chen: Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.
Asaf Bitton: Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.
Tracy Onega: Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA.
Kimberly Harris: Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.
Anna N A Tosteson: Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA.
BACKGROUND: Revised breast cancer screening guidelines have fueled debate about the effectiveness and frequency of screening mammography, encouraging discussion between women and their providers. OBJECTIVE: To examine whether primary care providers' (PCPs') beliefs about the effectiveness and frequency of screening mammography are associated with utilization by their patients. DESIGN: Cross-sectional survey data from PCPs (2014) from three primary care networks affiliated with the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium, linked with data about their patients' mammography use (2011-2014). PARTICIPANTS: PCPs (n = 209) and their female patients age 40-89 years without breast cancer (n = 30,233). MAIN MEASURES: Outcomes included whether (1) women received a screening mammogram during a 2-year period; and (2) screened women had >1 mammogram during that period, reflecting annual screening. Principal independent variables were PCP beliefs about the effectiveness of mammography and their recommendations for screening frequency. KEY RESULTS: Overall 65.2% of women received >1 screening mammogram. For women 40-48 years, mammography use was modestly lower for those cared for by PCPs who believed that screening was ineffective compared with those who believed it was somewhat or very effective (59.1%, 62.3%, and 64.7%; p = 0.019 after controlling for patient characteristics). Of women with PCPs who reported they did not recommend screening before age 50, 48.1% were nonetheless screened. For women age 49-74 years, the vast majority were cared for by providers who believed that screening was effective. Provider recommendations were not associated with screening frequency. For women ≥75 years, those cared for by providers who were uncertain about effectiveness had higher screening use (50.7%) than those cared for by providers who believed it was somewhat effective (42.8%). Patients of providers who did not recommend screening were less likely to be screened than were those whose providers recommended annual screening, yet 37.1% of patients whose providers recommended against screening still received screening. CONCLUSIONS: PCP beliefs about mammography effectiveness and screening recommendations are only modestly associated with use, suggesting other likely influences on patient participation in mammography.
