Who Follows Breast Cancer Screening Guidelines?
Abstract & Commentary
By Frank W. Ling, MD, Clinical Professor, Dept. of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville. Dr. Ling reports no financial relationship to this field of study.
Synopsis: A retrospective review of patient records representing preventive healthcare visits of women aged 50-69 revealed that gynecologists are more likely than family physicians or internists to follow breast cancer screening guidelines.
Source: Wallace AE, et al. Women's primary care providers and breast cancer screening: who's following the guidelines? Am J Obstet Gynecol. 2006;194:744-748.
The authors reviewed 472 records representing 16 million preventive healthcare visits in women from 50 to 69 years of age in the 2000 National Ambulatory Medical Care Survey. OB/GYN physicians were more likely to follow breast cancer screening guidelines, but, overall, mid-level providers are more likely than medical doctors or osteopaths to adhere to guidelines. Gynecologists performed breast examinations in 87% of preventive health visits compared to 33% for internists and 45% for family physicians. Gynecologists ordered mammography in 53% of cases compared to 20% and 22% for the other two specialties, respectively. Interestingly, 89% of internists and 90% of family physicians identified themselves as primary care providers, while only 15% of gynecologists did so.
Commentary
At a gut level, I knew this! Sometimes, don't you read an article and realize that it's common sense or that it truly represents your own clinical experience? This is just such an article. As a practicing generalist obstetrician/gynecologist for 28 years, I suspected that colleagues in my specialty adhered to breast cancer screening more than internists and family physicians. Now for those in the reading audience who are not OB/GYN physicians, please don't be offended. This is not a universal indictment. The teaching point that I took away from the article is that each of us, regardless of specialty, needs to address each patient's needs individually and separately. Don't assume that someone else is doing it. It certainly doesn't hurt to ask.
I'm surprised at many of the numbers that lead to the final conclusions. First, the percentage of providers in each of the specialties claiming a primary care role took me aback: I would have thought that family physicians would be 100% and the gynecology rate would be a little higher. The authors point out correctly that the family physician and internal medicine providers might, on a day-to-day basis, defer to their OB/GYN counterparts to order mammograms, perform breast exams, etc. I'm also interested that even in OB/GYN practices, not 100% of patients had breast exams done. Perhaps there were some patients who were being followed by general surgeons or breast cancer specialists to whom the OB/GYN provider was deferring? There are certainly patients in my practice who decline breast exams because they are seeing someone else for their breast problems.
Data like these reinforce to all of us the need to make sure that each of our patients does have a primary care provider who oversees screening protocols. Some practices are probably incredibly compulsive about documenting the need for breast exams and mammography. Others may not see it as a priority at all because the physicians in the practice do not consider themselves primary care providers. Between the two extremes are numerous different ways of addressing the issue. It takes little effort to set in motion a consistent method to make sure that somebody somewhere is addressing the breast cancer screening guidelines, eg, have the patient check off something as she signs in, or have the office assistant ask when vital signs are taken, or have a check off box stamped on the front of every chart that lists who is responsible for that specific patient.
As the commercial for the athletic shoe (no brand name to be mentioned) encouraged us, "Just Do It!"
A retrospective review of patient records representing preventive healthcare visits of women aged 50-69 revealed that gynecologists are more likely than family physicians or internists to follow breast cancer screening guidelines.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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