Breast Cancer Risk Assessment and Screening Practices Reported Via an Online Survey

Abstract

Background: Breast cancer screening guidelines differ between organizations, and significant variations in practice patterns exist. Previous evidence suggests that provider-level factors are the greatest contributors to risk assessment and screening practice variability. This study aimed to characterize provider factors associated with breast cancer risk assessment and screening practice patterns, and to assess perceived barriers to providing risk assessment.

Methods: An online survey was distributed to providers at a single academic institution and to providers publicly via social media (January to August 2022). Respondents in the United States who care for adult women at risk for the development of breast cancer were included.

Results: Most of the respondents in the 143 completed surveys were white/Caucasian (79%) females (90%) age 50 years or younger (79%), and whereas 97% discuss breast cancer screening with their patients, only 90% order screening mammograms. Risk factor assessment was common (93%), typically performed at the first visit (51%). Additional training in genetics or risk assessment was uncommon (17%), although the majority were interested but did not have the time or resources (55%). Although most (64%) did not perceive barriers to providing risk assessment or appropriate screening, the most common barriers were time (77%) and education (55%). Barriers were more common among family practice or obstetrics and gynecology (OB/GYN) providers and those who worked in an academic setting (all p < 0.05).

Conclusions: Breast cancer risk assessment and screening practices are highly variable. Although time is the major barrier to providing risk assessment, providers also need education. Primary care organizations could partner with breast cancer-focused societies for additional resources.

Keywords: Breast cancer; Breast cancer risk assessment; Breast cancer screening; Genetics.

Figure 1.. Reported age at which provider stops referring patients for screening mammograms among 128 respondents who reported ordering routing screening mammogram in a 2022 online survey of providers for women at risk of breast cancer.

Figure 2.. Reported type of risk factors assessed by 133 respondents who reported assessing individual risk factors in a 2022 online survey of providers for women at risk of breast cancer.

Abbreviations: BMI=body mass index.

Figure 3.. Reported approach/model/guideline used by 133 respondents who reported assessing individual risk factors in a 2022 online survey of providers for women at risk of breast cancer.

Abbreviations: AAFP=American Academy of Family Physicians; ACOG=American College of Obstetricians and Gynecologists; ACS=American Cancer Society; SBI= Society of Breast Imaging; ASBrS=American Society of Breast Surgeons; BOADICEA= Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm; NCCN= National Comprehensive Cancer Network; USPSTF=United States Preventative Services Task Force.

Figure 4.. Reported type of supplemental screening ordered by 118 respondents who reported ordering for supplemental screening for high-risk patients in a 2022 online survey of providers for women at risk of breast cancer.

Abbreviations: MRI=magnetic resonance imaging; ABUS=automated breast ultrasound.

Figure 5.. Greatest barriers perceived by 51 respondents who reported perceiving barriers to providing breast cancer risk assessment or appropriate screening in a 2022 online survey of providers for women at risk of breast cancer.