Objective
We sought to assess knowledge and adherence to the revised US Preventive Services Task Force breast cancer screening guidelines among gynecologic care providers.
Study Design
This was a cross-sectional descriptive study based on a survey conducted among gynecologic care providers.
Results
Forty providers completed the survey (80%). In response to the statement “The current recommended age to initiate breast cancer screening is … .,” 48.7% of providers responded in accordance with revised guidelines. For the statement “Women between the age of 50 and 74 years old are recommended to have screening mammography,” 46.2% of respondents answered in accordance. In response to the statement “The United States Preventative Services Task Force recommends teaching breast self-examination,” 71.8% of providers responded in accordance. A total of 37 respondents (92.5%) stated that they were aware of the revised guidelines, but 17 (42.4%) stated that they were applicable to their patient population.
Conclusion
Knowledge of the revised guidelines appeared to be relatively low in our provider sample.
Breast cancer is the second most commonly diagnosed cancer in women in the United States. It also represents the second leading cause of cancer death among women, second only to lung cancer. In 2010, the American Cancer Society estimated 207,090 new cases of invasive breast cancer and 39,840 deaths from breast cancer in the United States. The incidence of breast cancer has decreased by 2% per year from 1998 through 2007 and death rates from breast cancer have also declined since 1990. This decline has been attributed to earlier detection through mammography screening, increased awareness, and improved treatment. Although widespread use of screening has significantly reduced breast cancer mortality, mammography is not without risks or costs. A major challenge in developing cancer screening guidelines is to create guidelines that maximize screening benefits and minimize screening harms. In November 2009, the US Preventative Services Task Force (USPSTF) announced revised evidence-based guidelines for breast cancer screening. The justification of these changes was an effort to minimize screening harms while preserving maximal benefit. The USPSTF changes to the 2002 breast cancer screening guidelines consisted of 5 major changes. These changes are summarized in Table 1 .
| Variable | 2002 USPSTF guidelines | 2009 USPSTF guidelines |
|---|---|---|
| Age to begin mammograms | 40 y | 50 y a |
| Frequency of mammograms | Annually | Every 2 y |
| Age to end regular mammogram screening | No recommended age to stop screening | Insufficient evidence to assess benefits and harms of screening mammography in women aged ≥75 y |
| CBE | Insufficient evidence to recommend for or against routine CBE alone to screen for breast cancer | Insufficient evidence to assess additional benefits and harms of CBE beyond screening mammography in women aged ≥40 y |
| SBE | Insufficient evidence to suggest for or against either CBE or SBE | Recommends against SBE |
a Decision to start regular, biennial screening mammography before age 50 y should be an individual one and take patient context into account, including patient’s values regarding specific benefits and harms.
Since their release, the newly revised USPSTF guidelines for breast cancer screening have been met with strong opposition and resistance among both patients and providers. Now, a year after the release of the new guidelines, controversy among the media leading to confusion among patients and physicians remains. It is unclear if the changes in recommendations have affected the way physicians are practicing or if insurance reimbursement will change.
The objective of the current study is to assess the overall knowledge and adherence to the newly revised guidelines among gynecologic care providers in a large, urban academic hospital. In addition, this study will evaluate if the demographics of either patient or provider influence adherence to the new guidelines.
Materials and Methods
This was a cross-sectional descriptive study based on a survey conducted among gynecologic care providers at the New York Presbyterian Hospital-Weill Cornell Medical College. The study was exempt from institutional review board approval. Eighty physicians were identified as either full-time or voluntary providers within the department of obstetrics and gynecology. Providers were excluded if they were a subspecialist in the following divisions: maternal-fetal medicine, gynecologic oncology, reproductive endocrinology, and infertility, or if they only practiced obstetrics. This provided 50 evaluable providers. Surveys were distributed by a medical student who collected the survey when completed via fax, e-mail, or in person.
The survey obtained information on provider demographics, practice setting, and practice structure. The provider was then asked 3 questions evaluating knowledge base of current USPSTF breast cancer screening recommendations ( Figure 1 ). A summary of the current USPSTF recommendations was then provided for review. The survey ended with questions regarding the provider’s opinion and adherence to the new guidelines ( Figure 2 ). Physicians were asked to select 1 answer choice for each question. Providers were asked to respond based on patients at average risk of malignancy and with respect to guidelines established by the USPSTF. Providers completed the knowledge-based questions before viewing the current recommendations summary section. Tests of correlation included Kendall tau-b and Jonckheere-Terpstra. Tests of association included Cramer V, where appropriate, to evaluate possible relationships between variables. All statistical analysis was performed using SAS version 9.1 (SAS Institute, Cary, NC).
