title: Factors affecting breast cancer risk reduction practices among California physicians.
abstract: BACKGROUND
  Little is known about the incorporation of breast cancer risk reduction therapies into clinical practice.
  
  
  METHODS
  We assessed factors related to physicians' performance of breast cancer risk reduction practices through a self-administered survey. Subjects were California physicians in family medicine, internal medicine, or obstetrics/gynecology, identified through the AMA Masterfile. Physicians reported their breast cancer risk reduction practices (initiating patient counseling, referring patients for genetic evaluation, and prescribing tamoxifen or raloxifene) as well as barriers to counseling.
  
  
  RESULTS
  Of 1647 eligible physicians, 822 responded. Eighty-six percent reported initiating counseling, 45% referred a patient for genetic evaluation, 31% prescribed raloxifene, and 11% prescribed tamoxifen for breast cancer prevention in the past year. The leading frequent barriers to counseling were "not enough time" (40.3%) and "insufficiently informed about risk reduction options" (19.1%). Multivariate analysis showed that a training and role factors scale was negatively associated with all risk reduction practices, and number of breast cancer diagnoses per year was positively associated with referring for genetic evaluation and prescribing chemoprevention.
  
  
  CONCLUSIONS
  Physicians in primary care specialties report participation in several breast cancer risk reduction activities. Issues related to physician training and role in risk reduction affect the implementation of these practices.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, San Francisco, CA 94143-0856, USA. ckaplan@itsa.ucsf.edu
authors.forename: Celia Patricia
authors.initials: CP
authors.lastname: Kaplan
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.forename: Eliseo J
authors.initials: EJ
authors.lastname: Pérez-Stable
authors.forename: Genevieve
authors.initials: G
authors.lastname: Des Jarlais
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gregorich
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*; D002140:California / Q000453:epidemiology; D005260:Female; D005817:Genetic Counseling; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000592:standards* / Q000639:trends; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D012017:Referral and Consultation; D018570:Risk Assessment; D011795:Surveys and Questionnaires