Assessment of and Interventions for Women at High Risk for Breast or Ovarian Cancer: A Survey of Primary Care Physicians

Abstract

As clinical guidelines for cancer prevention refer individuals to primary care physicians (PCP) for risk assessment and clinical management, PCPs may be expected to play an increasing role in cancer prevention. It is crucial that PCPs are adequately supported to assess an individual's cancer risk and make appropriate recommendations. The objective of this study is to assess use, familiarity, attitude, and behaviors of PCPs regarding breast and ovarian cancer risk and prevention, to better understand the factors that influence their prescribing behaviors. We conducted a cross-sectional, web-based survey of PCPs in the United States, recruited from an opt-in healthcare provider panel. Invitations were sent in batches until the target sample size of 750 respondents (250 each for obstetrics/gynecology, internal medicine, and family medicine) was met. Self-reported use of breast/ovarian cancer risk assessments was low (34.7%-59.2%) compared with discussion of cancer family history (96.9%), breast exams (87.1%), and mammograms (92.8%). Although most respondents (48.0%-66.8%) were familiar with cancer prevention interventions, respondents who reported to be less familiar were more likely to report cautious attitudes. When presented with hypothetical cases depicting patients at different breast/ovarian cancer risks, up to 34.0% of respondents did not select any of the clinically recommended course(s) of action. This survey suggests that PCP use of breast/ovarian cancer risk assessment tools and ability to translate the perceived risks to clinical actions is variable. Improving implementation of cancer risk assessment and clinical management guidelines within primary care may be necessary to improve the appropriate prescribing of cancer prevention interventions.Prevention Relevance: Primary care physicians are becoming more involved in cancer prevention management, so it is important that cancer risk assessment and medical society guideline recommendations for cancer prevention are better integrated into primary care to improve appropriate prescribing of cancer prevention interventions and help reduce cancer risk.

Figure 1.

Breakdown of physician responses for clinically recommended course of action for case vignettes presented in Table 5. A) Patient 1 (40 years old; no personal history of breast cancer; no personal history of DCIS; no personal history of LCIS; no first-degree relative with breast cancer); B) Patient 2 (35 years old; no personal history of breast cancer; no personal history of DCIS; no personal history of LCIS; one first-degree relative with breast cancer, diagnosed before age 50; one first-degree relative with ovarian cancer); C) Patient 3 (35 years old; no personal history of breast cancer; no personal history of DCIS; no personal history of LCIS; two first-degree relatives with breast cancer; found to carry a pathogenic BRCA1 mutation); D) Patient 4 (65 years old; no personal history of breast cancer; no personal history of DCIS; no personal history of LCIS; no first-degree relatives with breast cancer; one breast biopsy showing atypical hyperplasia). Light gray bars: percentage of physicians who selected the specified clinically recommended course of action; dark gray bars: percentage of physicians who selected both clinically recommended courses of actions; white bars: percentage of physicians who selected neither of the clinically recommended specified courses of action.