title: Physicians' beliefs about breast cancer surveillance testing are consistent with test overuse.
abstract: BACKGROUND
  Overuse of surveillance testing for breast cancer survivors is an important problem but its extent and determinants are incompletely understood. The objectives of this study were to determine the extent to which physicians' breast cancer surveillance testing beliefs are consistent with test overuse, and to identify factors associated with these beliefs.
  
  
  METHODS
  During 2009-2010, a cross-sectional survey of US medical oncologists and primary care physicians (PCPs) was carried out. Physicians responded to a clinical vignette ascertaining beliefs about appropriate breast cancer surveillance testing. Multivariable analyses examined the extent to which test beliefs were consistent with overuse and associated with physician and practice characteristics and physician perceptions, attitudes, and practices.
  
  
  RESULTS
  A total of 1098 medical oncologists and 980 PCPs completed the survey (response rate 57.5%). Eighty-four percent of PCPs [95% confidence interval (CI), 81.4%-86.5%] and 72% of oncologists (95% CI, 69.8%-74.7%) reported beliefs consistent with blood test overuse, whereas 50% of PCPs (95% CI, 47.3%-53.8%) and 27% of oncologists (95% CI, 23.9%-29.3%) reported beliefs consistent with imaging test overuse. Among PCPs, factors associated with these beliefs included smaller practice size, lower patient volume, and practice ownership. Among oncologists, factors included older age, international medical graduate status, lower self-efficacy (confidence in knowledge), and greater perceptions of ambiguity (conflicting expert recommendations) regarding survivorship care.
  
  
  CONCLUSIONS
  Beliefs consistent with breast cancer surveillance test overuse are common, greater for PCPs and blood tests than for oncologists and imaging tests, and associated with practice characteristics and perceived self-efficacy and ambiguity about testing. These results suggest modifiable targets for efforts to reduce surveillance test overuse.
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME 04101, USA. hanp@mmc.org
authors.forename: Paul K J
authors.initials: PK
authors.lastname: Han
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.forename: Anne-Michelle
authors.initials: AM
authors.lastname: Noone
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Virgo
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data*; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D014481:United States; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*