Study Suggests That Where Instructions Disagree, Doctors ’Experiences With Their Patients, Family and Friends Contaminate Breast Cancer Recommendations

A new national survey suggests that doctors ’experiences of patients, friends and family have shaped their methods of diagnosing breast cancer.

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The results of a national survey of more than 800 physicians suggest that their experiences with patients, family members and friends with breast cancer are included in their recommendations for routine mammograms. Specifically, doctors who report knowing at least one patient, family member or friend who has a poor record of breast cancer and has not been diagnosed further recommend routine screening for their younger and older patients, age groups where routine screening is controversial.

A report of the findings, published on December 4 at JAMA Internal Medicine, highlights the impact of physicians ’social networks on their adherence to nationally recognized guidelines for breast cancer screening.

“Our findings suggest that we need to help clinicians better understand the impact of the personal experiences of friends and family members, as well as their patients, on their procedures.” Craig Evan Pollack, MD, MHS, associate professor of medicine at Johns Hopkins University School of Medicine and lead author of the study.

Current instructions for younger and older women are inconsistent. For example, the American Cancer Society recommends self-determination for women ages 40-44, annual screening for women beginning at age 45, and biennial screening for women 55. up, while the U.S. Preventive Services Task Force recommends self-determination for women ages 40- 49 and biennial mammograms for women 50-74.

For the new research, part of the Breast Cancer Social Networks study, Pollack and colleagues sent a survey of 2,000 primary care physicians between May and September 2016. Participants randomly taken from the American Medical Association Physician Masterfile, a database of more than 1.4 million physicians. , residents and medical students of the United States.

The survey asked respondents to detail the experiences of two women they knew (a patient and a friend or family member) who were diagnosed with breast cancer, and to identify which cancer had the most great impact on them. Each experience is classified as: a) diagnosed by diagnosis and with good prognosis; b) cannot be diagnosed by examination and has a good prognosis; c) is diagnosed by examination and has poor prognosis; d) cannot be diagnosed by diagnosis and poor prognosis; oe) unknown analysis or prediction.

Poor prognosis is defined as metastatic disease (disease that has spread) at the time of diagnosis or death from cancer.

Respondents were also asked to report whether they generally recommended routine screening of mammograms in at-risk patients with no family history or no breast issues in groups aged 40- 44, 45-49 and older 75 years.

A total of 848 doctors reported 1,631 women they knew being diagnosed with breast cancer, 771 of these were patients, 381 family members and 474 other social members. network.

Of the physicians, 246 practiced in internal medicine, 379 practiced in family medicine and 223 practiced in gynecology. The majority were male (461 of 848, or 54.4 percent) and non -Hispanic white (605 of 848, or 71.3 percent).

Pollack and colleagues found that doctors who reported at least one social network member having a poor prognosis without screening were more likely to recommend routine screening of older women. 40-44 years (92.7 vs. 85.6 percent) and older at 75 years compared with those without (84 vs. 68.3 percent).

“As a first step toward increasing adherence to guidelines, it may be necessary to create messaging opportunities and procedures that help physicians identify experiences that will help shape their recommendations,” he said. Pollack.

Other authors of this study included Kala Visvanathan of the Johns Hopkins Bloomberg School of Public Health, Archana Radhakrishnan of the University of Michigan, Andrew M. Parker and Sarah A. Nowak of RAND Corporation, and Xinwei Chen of the University of Pennsylvania.

This study was funded by the National Cancer Institute (R21CA194194-02).

COI: At the time of the study, Pollack’s salary was supported by a grant from the National Cancer Institute.

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