Factors affecting breast cancer risk reduction practices among California physicians.
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.
Kaplan
Celia Patricia
CP
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
Haas
Jennifer S
JS
Pérez-Stable
Eliseo J
EJ
Des Jarlais
Genevieve
G
Gregorich
Steven E
SE
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