title: Physicians' attitudes and behaviour toward screening mammography in women 40 to 49 years of age.
abstract: OBJECTIVE
  To determine family physicians' attitudes and behaviour toward screening mammography, breast self-examination, and breast awareness in women aged 40 to 49 at average risk of breast cancer.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Women's College Hospital and Sunnybrook Health Sciences Centre, both in Toronto, Ont.
  
  
  METHODS
  Family medicine residents, fellows, and staff physicians at 2 academic family practice health centres affiliated with the University of Toronto (n = 95).
  
  
  METHODS
  Physicians' answers to questions about offering screening mammography and promoting breast self-examination and breast awareness.
  
  
  RESULTS
  Fifty-two completed surveys were returned (response rate 55%). Less than half of all surveyed family physicians (46%) routinely offered screening mammography to women aged 40 to 49 who were at average risk of breast cancer. Although 40% of physicians did not think breast cancer screening was necessary for women aged 40 to 49, 62% indicated that they would offer screening if their patients requested it. Physicians' reasons not to offer screening included no evidence of decreasing breast cancer deaths (63%), grade A recommendation to screen women starting at age 50 and not at age 40 (25%), and the harms of screening outweighing the benefits (19%). Physicians' reasons to offer screening included patient request (55%), personal clinical practice experience or mentors' recommendations (27%), and guideline recommendations (18%). Breast self-examination was not recommended by most physicians (74%), yet most encouraged women to practise breast awareness (81%).
  
  
  CONCLUSIONS
  Many women at average risk of breast cancer are not being offered the opportunity to discuss and initiate mammographic screening before 50 years of age. While breast-self examination is not recommended, most physicians promote breast awareness.
authors.affiliation: Family Practice Research Office, Women's College Hospital, BH216, 60 Grosvenor St, Toronto, ON M5S 1B6. patricia.smith@learnlink.mcmaster.ca
authors.forename: Patricia
authors.initials: P
authors.lastname: Smith
authors.forename: Susan
authors.initials: S
authors.lastname: Hum
authors.forename: Vered
authors.initials: V
authors.lastname: Kakzanov
authors.forename: M Elisabeth
authors.initials: ME
authors.lastname: Del Giudice
authors.forename: Ruth
authors.initials: R
authors.lastname: Heisey
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D016504:Breast Self-Examination / Q000523:psychology; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D005194:Family Practice; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D009864:Ontario; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012306:Risk; D019037:Urban Health Services