Physicians' reactions to change in recommendations for mammography screening.
BACKGROUND
In December 1993 the National Cancer Institute (NCI) decided to replace its mammography screening guidelines with a Statement of Evidence on Breast Cancer Screening. The Statement of Evidence represented a departure from the institute's previous policy of recommending routine mammography screening in women 40-49 and annual screening in women 50 and over. This study assesses knowledge of and attitudes toward the Statement of Evidence among primary care physicians. In addition, we explore the extent to which physicians changed their individual clinical policies on mammography screening in response to the Statement of Evidence.


METHODS
Between October 1994 and June 1995, 545 randomly selected North Carolina primary care physicians completed a mailed questionnaire (overall survey response rate = 42%).


RESULTS
Awareness of the Statement of Evidence was high (83%), but attitudes toward it were negative, with a majority of physicians stating that the change in policy was confusing to women and physicians. About 8% of physicians who were aware of the Statement of Evidence changed their practice accordingly. Most physicians reported recommending routine mammography screening in women 40-49 and annual screening in women 50 and over. A majority stated they believe scientific evidence supports these practices.


CONCLUSIONS
When faced with a new policy in which guidelines are no longer provided and evidence supporting less use of an established technology is conveyed, physicians demonstrated disinclination to change. The impact of changes in recommendations on physician practice is an important consideration for those who develop and promote screening policies.
Klabunde
C N
CN
Cancer Prevention Fellowship Program, National Cancer Institute, Bethesda, Maryland 20892-7344, USA. klabundc@dcpcepn.nci.nih.gov
O'Malley
M S
MS
Kaluzny
A D
AD
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003625:Data Collection; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008327:Mammography; D008875:Middle Aged; D010820:Physicians; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires