title: Provider Attitudes and Screening Practices Following Changes in Breast and Cervical Cancer Screening Guidelines.
abstract: BACKGROUND
  Changes to national guidelines for breast and cervical cancer screening have created confusion and controversy for women and their primary care providers.
  
  
  OBJECTIVE
  To characterize women's primary health care provider attitudes towards screening and changes in practice in response to recent revisions in guidelines for breast and cervical cancer screening.
  
  
  METHODS
  In 2014, we distributed a confidential web and mail survey to 668 women's health care providers affiliated with the four clinical care networks participating in the three PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium breast cancer research centers (385 respondents; response rate 57.6 %).
  
  
  METHODS
  We assessed self-reported attitudes toward breast and cervical cancer screening, as well as practice changes in response to the most recent revisions of the U.S. Preventive Services Task Force (USPSTF) recommendations.
  
  
  RESULTS
  The majority of providers believed that mammography screening was effective for reducing cancer mortality among women ages 40-74 years, and that Papanicolaou (Pap) testing was very effective for women ages 21-64 years. While the USPSTF breast and cervical cancer screening recommendations were widely perceived by the respondents as influential, 75.7 and 41.2 % of providers (for mammography and cervical cancer screening, respectively) reported screening practices in excess of those recommended by USPSTF. Provider-reported barriers to concordance with guideline recommendations included: patient concerns (74 and 36 % for breast and cervical, respectively), provider disagreement with the recommendations (50 and 14 %), health system measurement of a provider's screening practices that use conflicting measurement criteria (40 and 21 %), concern about malpractice risk (33 and 11 %), and lack of time to discuss the benefits and harms with their patients (17 and 8 %).
  
  
  CONCLUSIONS
  Primary care providers do not consistently follow recent USPSTF breast and cervical cancer screening recommendations, despite noting that these guidelines are influential.
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA. jhaas@partners.org.|Harvard Medical School, Boston, MA, USA. jhaas@partners.org.|Harvard T.H. Chan School of Public Health, Boston, MA, USA. jhaas@partners.org.|Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA. jhaas@partners.org.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.affiliation: University of Vermont, Burlington, VT, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sprague
authors.affiliation: Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.affiliation: Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Chen
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Asaf
authors.initials: A
authors.lastname: Bitton
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Elisabeth F
authors.initials: EF
authors.lastname: Beaber
authors.affiliation: Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: University of Vermont, Burlington, VT, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: MacLean
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Harris
authors.affiliation: University of Pennsylvania and the Philadelphia VA Medical Center, Philadelphia, PA, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Yamartino
authors.affiliation: University of Vermont, Burlington, VT, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Howe
authors.affiliation: Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA.
authors.forename: Loretta
authors.initials: L
authors.lastname: Pearson
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Feldman
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Brawarsky
authors.affiliation: University of Pennsylvania and the Philadelphia VA Medical Center, Philadelphia, PA, USA.
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Schapira
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology
keywords: breast cancer screening; cervical cancer screening; clinical practice guidelines; primary care; provider practice patterns