Impact of a physician intervention program to increase breast cancer screening

In order to improve compliance with the National Cancer Institute\u27s breast cancer screening guidelines, we developed a multifaceted intervention designed to alter physician screening practice. A pre-post test, two-community design was used. Primary care physicians in one community served as the control. Data were collected by two mailed surveys (1987 and 1990). Response rates were 61% and 64%, respectively. The physician intervention program consisted of a hospital-based continuing medical education program and an outreach component which focused on implementing a reminder system. Outcome measures were self-reported attitudinal, knowledge, and screening practices changes. In spite of an impressive change in comparison community physicians\u27 practice, the difference in change over time in the intervention community physicians\u27 ordering of annual mammography compared to the change in the comparison community physicians\u27 ordering was significant (P = 0.04). The adjusted odds ratio is nearly 8. We conclude that our in-service continuing medical education program was successful in improving breast cancer screening practices among primary care physicians

Physician compliance with mammography guidelines: barriers and enhancers

BACKGROUND: Primary care physicians are increasingly the gatekeepers to clinical preventive services including mammography utilization. Moreover, lack of physician recommendation is a major reason for patient failure to obtain screening. A study was designed to examine the attitudes, beliefs, and practices with regard to breast cancer screening as self-reported by primary care physicians. The variables associated with compliance or lack of compliance with screening guidelines are emphasized. METHODS: One hundred sixteen primary care physicians practicing in two New England communities responded to a mailed survey. The survey included questions on attitudes and beliefs about breast cancer screening, as well as questions about perceived barriers and actual screening practices. RESULTS: Fifty-seven percent of the respondents reported ordering annual mammograms for their female patients aged 50 to 75 years. An additional 21 percent reported ordering biannual mammograms for women in this age group. Strongly associated with ordering annual mammograms were beliefs in the benefits of mammography and the perception of community consensus regarding breast cancer screening. A strong positive association of practicing in a group setting and mammography guideline compliance was documented. Middle-aged physicians in solo practice reported the poorest screening compliance. CONCLUSIONS: The level of physician compliance with the standard of annual mammography screening is low (57 percent). The three most important determinants of annual screening suggest ways to improve physician compliance: improve physician attitudes about the benefits of mammography, build further on the medical community\u27s consensus regarding the appropriateness and importance of the annual guidelines, target the poorest compliers with special messages or programs

Feasibility of universal screening mammography. Lessons from a community intervention

It is estimated that 44,500 American women will die of breast cancer in 1991. The breast cancer screening guidelines of the American Cancer Society and the National Cancer Institute calling for annual mammography for all women older than 50 years have been endorsed by numerous professional groups. Third-party reimbursement for screening mammography is becoming more prevalent, and payment for screening mammography is now a Medicare benefit. Our studies, conducted as part of a National Cancer Institute grant to increase the routine use of screening mammography and clinical breast examination in women 50 to 75 years of age, have uncovered a number of significant barriers to the implementation of screening guidelines among women, primary care physicians, and providers of mammography services. These barriers, as well as methods to assure the quality of mammography, need to be addressed before universal screening is feasible

Impact of a breast cancer screening community intervention

BACKGROUND. Efforts to detect breast cancer in its early stages are necessary to reduce breast cancer-associated mortality. This study evaluated the impact of a multicomponent intervention implemented between 1987 and 1990 to increase a community\u27s utilization of breast cancer screening by women over 50 years of age. METHODS. The study used a pretest/post-test two-community design, with one community assigned as the intervention community and the other as the comparison. The intervention consisted of a comprehensive physician involvement component and a community education effort. To assess the overall impact of the interventions, we measured women\u27s participation in screening via random digit dial telephone surveys at three time points, each approximately 18 months apart. RESULTS. Over the course of the study, there were dramatic improvements in breast cancer screening participation in both communities. However, the intervention city showed more improvement in selected variables than did the comparison community in the early phases of the project between baseline and midpoint. These included increased advice by physicians to have mammograms, increased awareness that screening is necessary in the absence of symptoms, increased awareness that many women over 50 have mammograms, decreased perception of barriers to clinical breast exam, and an increase in the proportion of women having a clinical breast exam. In addition, significantly fewer women in the intervention city than in the comparison city reported never having had a mammogram at midpoint. CONCLUSIONS. The findings demonstrate limited impact of a community intervention during a period of increasing adoption of mammography screening, in part, due to this rapidly rising secular trend. Additionally, increased activities in the comparison community were documented. Therefore, as incidence of screening increases, targeted activities aimed at population subgroups are warranted, and evaluation designs need to include multiple comparison groups or broader geographic random samples