Of the original sample of 1,000 physicians, 248 physicians who had incorrect addresses, were no longer practicing, were not a primary care physician, had no female patients, or had died and were excluded. Twenty-six subjects refused to participate. Of the remaining 726 questionnaires, 383 surveys were received after all attempts to recover the surveys. After excluding 32 incomplete surveys, a total of 351 questionnaires were available for analysis. The response rate was therefore 48.3%. Responders did not differ significantly from non-responders in gender, region of the country, specialty or type of degree (MD vs. DO). However, responders had graduated from medical school more recently than non-responders (p< 0.01).
The demographic and practice characteristics of the participating physicians are listed in . The mean age was 45.6 years and just over two-thirds were male. Forty-one percent practiced family practice, 39% internal medicine, and 19% obstetrics and gynecology. The mean number of years since graduating from medical school was 17.2. Approximately half had an affiliation with an academic medical center. Twelve percent of physicians had a close family member (parent, sister, spouse, daughter) who was diagnosed with breast cancer. Physician use of methods of breast cancer risk assessment in the last 12 months revealed that 88% of physicians had discussed breast cancer risk with a patient in the last 12 months (26% 1–6 times, 13% 7–12 times, 13% 12–24 times and 37% >24 times), 18% of physicians had used software to calculate breast cancer risk (11% 1–6 times, 3% 7–12 times, 1% 12–24 times and 3% >24 times) and 48% of physicians had ordered or referred a patient for genetic testing for BRCA 1/2 mutations (33% 1–6 times, 8% 7–12 times, 4% 12–24 times and 3% >24 times) in the last 12 months (). No physicians had used software to calculate breast cancer risk without discussing breast cancer risk and only 5 physicians had ordered or referred for genetic testing without reporting have discussed breast cancer risk factors.
Physician and practice characteristics and use of methods of breast cancer risk assessment strategies in last 12 months
The associations between physician and practice characteristics and breast cancer risk assessment strategies are shown in . Physician specialty was significantly associated with use of risk software and use of BRCA1/2 testing with higher rates among obstetrician gynecologists than internists or family practitioners. Physician specialty was also correlated with discussion of risk factors however the association did not reach statistical significance. The number of primary care providers in the practice was significantly associated with discussion of breast cancer risk factors and there was a trend towards an association with use of BRCA1/2 testing. In addition, having a family member with breast cancer was associated with use of software to calculate risk. Not surprisingly, use of each of these breast cancer risk assessment strategies increased with the average number of patients seen per week.
Knowledge of breast cancer risk factors was significantly higher among physicians who had used risk assessment software (mean knowledge score 0.71 for users vs. 0.65 for non-users; p<0.01), but was not associated with having discussed breast cancer risk or with having ordered genetic testing for BRCA 1/2 mutations (). The belief that many patients asked for risk information was higher among physicians who had discussed breast cancer risk (p<0.01), but was not significantly associated with use of software. None of the other attitudes were associated with use of the breast cancer risk assessment strategies.
Physician knowledge, attitudes and use of methods of breast cancer risk assessment strategies in last 12 months. For attitudes, the table shows the n and proportion of physicians who agree or strongly agree with the attitude statement.
The results of the multivariate logistic regression models are shown in . Physician specialty remained strongly associated with each of the breast cancer risk assessment strategies, with greater odds among obstetrician-gynecologists than internists or family practitioners (OR 3.35; 95%CI 1.01–11.13 for discussion of risk factors; OR 5.37; 95% CI 2.54–11.55 for use of software and OR 2.36 95% CI 1.24–4.49 for use of BRCA1/2 testing). Being in solo practice was inversely associated with discussion of risk factors and use of BRCA1/2 testing use (OR 0.14; 95%CI 0.04–0.56 for discussion of risk factors; OR 0.27; 95% CI 0.07–0.96 for use of BRCA1/2 testing). There was a trend to an inverse association with use of risk software but it did not meet statistical significance. In addition, use of breast cancer risk software was associated with greater knowledge of breast cancer risk factors (OR 4.57; 95% 1.17–17.08) and having a family member with breast cancer (OR 2.49, 95% CI 1.27–6.32), while discussion of breast cancer risk factors was associated with having patients who asked for information about breast cancer risk (OR 24.60, 95% CI 3.23–188.94).
Table 3 Adjusted association between physician demographics, attitudes, knowledge and physician’s use of methods of breast cancer risk assessment. Models include all the variables in the table as well as physician age, gender and number of patients seen (more ...)