Breast Cancer Screening Practices for High-Risk Women: A Cross-Sectional Survey of Primary Care Providers

Abstract

Background: Little literature exists on primary care providers' knowledge and preferences toward breast cancer screening for high-risk women. Materials and Methods: A cross-sectional web-based survey of primary care providers in Minnesota was conducted in 2016. The primary aim was to determine the breast cancer screening practices of primary care providers for women at high risk for breast cancer. A multipart questionnaire focused on breast cancer screening practices for high-risk women and perceived risks/benefits of breast cancer screening was administered. Statistical analyses, included descriptive statistics and tests of differences in screening practices and knowledge across key professional characteristics, were conducted. Results: Eight hundred five primary care providers completed the survey (7.7% response). Participants were predominantly female (72.2%); 43.9% were physicians, 11.4% physician assistants, and 44.8% advanced practice registered nurses. One-quarter of providers recommended mammography and breast magnetic resonance imaging (MRI) for high-risk women ages 40-49 years. There were no differences in breast MRI recommendations based on years of experience or practice setting. In high-risk women with prior chest radiation and an increased risk of breast cancer, for whom guidelines recommend mammography and MRI, 75.0% of providers recommended mammography, but only 44.3% recommended breast MRI. Recent continuing education on breast cancer screening was associated with providers being more comfortable giving high-risk screening recommendations (p = 0.002). Conclusions: Most primary care providers believe mammography is helpful in women at high risk for breast cancer. Less than half of practitioners, however, recommend breast MRI to screen women at high risk for breast cancer, despite guidelines promoting the use of breast MRI. Increased provider education is warranted.

Keywords: breast cancer; cancer screening; preventive care; women's health.

FIG. 1.

Providers' recommendations for breast cancer screening of a 40-year old treated with mantle radiation for Hodgkin lymphoma at 20 years. National guidelines recommend breast MRI and mammogram. MRI, magnetic resonance imaging.