Provider Attitudes and Screening Practices Following Changes in Breast and Cervical Cancer Screening Guidelines

Abstract

Background: Changes to national guidelines for breast and cervical cancer screening have created confusion and controversy for women and their primary care providers.

Objective: To characterize women's primary health care provider attitudes towards screening and changes in practice in response to recent revisions in guidelines for breast and cervical cancer screening.

Design, setting, participants: In 2014, we distributed a confidential web and mail survey to 668 women's health care providers affiliated with the four clinical care networks participating in the three PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium breast cancer research centers (385 respondents; response rate 57.6 %).

Main measures: We assessed self-reported attitudes toward breast and cervical cancer screening, as well as practice changes in response to the most recent revisions of the U.S. Preventive Services Task Force (USPSTF) recommendations.

Key results: The majority of providers believed that mammography screening was effective for reducing cancer mortality among women ages 40-74 years, and that Papanicolaou (Pap) testing was very effective for women ages 21-64 years. While the USPSTF breast and cervical cancer screening recommendations were widely perceived by the respondents as influential, 75.7 and 41.2 % of providers (for mammography and cervical cancer screening, respectively) reported screening practices in excess of those recommended by USPSTF. Provider-reported barriers to concordance with guideline recommendations included: patient concerns (74 and 36 % for breast and cervical, respectively), provider disagreement with the recommendations (50 and 14 %), health system measurement of a provider's screening practices that use conflicting measurement criteria (40 and 21 %), concern about malpractice risk (33 and 11 %), and lack of time to discuss the benefits and harms with their patients (17 and 8 %).

Conclusions: Primary care providers do not consistently follow recent USPSTF breast and cervical cancer screening recommendations, despite noting that these guidelines are influential.

Keywords: breast cancer screening; cervical cancer screening; clinical practice guidelines; primary care; provider practice patterns.

Fig. 1

Provider report of cancer screening efficacy by modality and age group

Fig. 2

Self-reported changes in screening recommendations since revised USPSTF recommendations. 2009 breast cancer screening recommendations; 2012 cervical cancer screening recommendations

Fig. 3

Report of patient request to receive screening in excess of USPSTF recommendations. 2009 breast cancer screening recommendations; 2012 cervical cancer screening recommendations ⁱ ‘Excess’ defined as any mammography before 50 ⁱⁱ ‘Excess’ defined as annual screening ⁱⁱⁱ ‘Excess’ defined as continuation of screening ^iv ‘Excess’ defined as more than Pap testing every 3 years ^v ‘Excess’ defined as more than Pap and HPV co-testing every 5 years. ^vi ‘Excess’ defined as continuation of Pap testing