Breast cancer risk assessment and management in primary care: provider attitudes, practices, and barriers.
BACKGROUND
We surveyed primary care providers to evaluate breast cancer risk assessment and management practices.


METHODS
Primary care providers included staff (attendees, fellows, nurse practitioners) and residents practicing >or=1 session/week in an outpatient general medicine practice or community practices. Of 201 eligible providers, 107 (53%) completed a self-administered questionnaire ascertaining attitudes, perceived barriers, and clinical practices related to assessing and managing breast cancer risk.


RESULTS
Of providers, 96% mostly or definitely agreed that assessing breast cancer risk was a primary care provider's responsibility. In assessing risk, most providers reported usually or always asking about family history (71%), but fewer usually or always ask about parity (48%), biopsies (40%), or menarche (35%), and most never calculate Gail scores (76%). In managing women at high risk for breast cancer, many providers reported usually or always communicating increased risk to patients (58%) and tailoring screening based on risk (53%); however fewer providers usually or always discuss chemoprevention (13%) or genetic testing (16%) or refer to specialists (35%). Addressing more immediate issues (25%) and lacking confidence in knowledge of risk and risk assessment (20%) were the most commonly reported barriers to assessing risk (n=83).


CONCLUSIONS
Primary care providers generally assess breast cancer risk primarily using family history, potentially missing women at increased risk based on other criteria. In addition, although providers tailor screening and refer women at high risk to specialists, they infrequently discuss chemoprevention or genetic testing. Addressing perceived barriers to assessing risk may improve care.
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway (MS) K-53, Atlanta, GA 30341, USA. SSabatino@cdc.gov
Susan A
SA
Sabatino
Ellen P
EP
McCarthy
Russell S
RS
Phillips
Risa B
RB
Burns
D001943:Breast Neoplasms; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012306:Risk; D018570:Risk Assessment; D011795:Surveys and Questionnaires