Factors influencing mammogram ordering at the time of the office visit

Abstract

Background: Breast cancer is the second most common cause of cancer death in women, with mammographic screening the only modality shown to decrease the death rate. However, only 17% to 41% of women have ever been screened, and multiple barriers to screening have been identified. This study examined physician and patient factors at a single encounter to explore components influencing mammography ordering.

Methods: Ten family physicians in a primary care research network completed daily data cards on encounters with women presenting for annual examinations, chronic problems, or breast-related complaints. Information collected included patient age, personal or family history of breast cancer, physician's perception of expected compliance, previous mammogram results, breast examination, physician's perception of need for a mammogram, whether the mammogram was ordered, and the patient's method of payment for the test.

Results: Eight hundred thirty-nine patients were entered into the study, and 277 mammograms were ordered. Mammograms were ordered for a greater percentage of patients with insurance (36%) than for those without insurance (26%) (P < .001). A multivariate analysis indicated that several factors helped to correctly classify 90% of mammogram ordering: the patient was making a first visit, a breast-related visit, or a visit for an annual examination; the patient had had a previous mammogram; had a breast examination at the current visit or within the past year; and the physician believed the patient would comply and believed that a mammogram was indicated.

Conclusions: Factors unique to a physician-patient visit influence the physician with regard to ordering a mammogram, including the type of visit, whether the physician believes a mammogram is indicated, and the cost.