Publications (26) View all
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Article: Breast MRI Use Uncommon among U.S. Women.
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ABSTRACT: BACKGROUND: The goal of breast cancer screening is to reduce breast cancer mortality. Mammography is the standard screening method for detecting breast cancer early. Breast magnetic resonance imaging (MRI) is recommended to be used in conjunction with mammography for screening subsets of women at high risk for breast cancer. We offer the first study to provide national estimates of breast MRI use among women in the United States. METHODS: We analyzed data from women who responded to questions about having a breast MRI on the 2010 National Health Interview Survey. We assessed report of having a breast MRI and reasons for it by sociodemographic characteristics and access to health care and computed 5-year and lifetime breast cancer risk using the Gail model. RESULTS: Among 11,222 women who responded, almost 5% reported ever having a breast MRI and 2% reported having an MRI within the 2 years preceding the survey. Less than half of the women who reported having a breast MRI were at increased risk. Approximately 60% of women reported having the breast MRI for diagnostic reasons. Women who ever had a breast MRI were more likely to be older, black, and insured and to report a usual source of health care compared to women who reported no MRI. CONCLUSIONS: Breast MRI use may be underused or overused in certain subgroups of women. Impact: As access to health care improves, the use of breast MRI and the appropriateness of its use for breast cancer detection will be important to monitor.Cancer Epidemiology Biomarkers & Prevention 11/2012; · 4.12 Impact Factor -
Article: Breast cancer screening among adult women--Behavioral Risk Factor Surveillance System, United States, 2010.
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ABSTRACT: Breast cancer continues to have a substantial impact on the health of women in the United States. It is the most commonly diagnosed cancer (excluding skin cancers) among women, with more than 210,000 new cases diagnosed in 2008 (the most recent year for which data are available). Incidence rates are highest among white women at 122.6 per 100,000, followed by blacks at 118 per 100,000, Hispanics at 92.8, Asian/Pacific Islanders at 87.9, and American Indian/Alaskan Natives at 65.6. Although deaths from breast cancer have been declining in recent years, it has remained the second leading cause of cancer deaths for women since the late 1980s with >40,000 deaths reported in 2008. Although white women are more likely to receive a diagnosis of breast cancer, black women are more likely to die from breast cancer than women of any other racial/ethnic group. In addition, studies have demonstrated that nonwhite minority women tend to have a more advanced stage of disease at the time of diagnosis. Breast cancer also occurs more often among women aged ≥50 years, those with first-degree family members with breast cancer, and those who have certain genetic mutations. Understanding who is at risk for breast cancer helps inform guidelines for who should get screened for breast cancer.MMWR. Morbidity and mortality weekly report 06/2012; 61 Suppl:46-50. -
Article: Prevalence of colorectal cancer screening among adults--Behavioral Risk Factor Surveillance System, United States, 2010.
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ABSTRACT: Among cancers that affect both men and women, colorectal cancer is the second leading cause of cancer death. In 2007 (the most recent year for which data are available), >142,000 persons received a diagnosis for colorectal cancer and >53,000 persons died. Screening for colorectal cancer has been demonstrated to be effective in reducing the incidence of and mortality from the disease. In 2008, the U.S. Preventive Services Task Force (USPSTF) recommended that persons aged 50-75 years at average risk for colorectal cancer be screened by using one or more of the following methods: high-sensitivity fecal occult blood testing (FOBT) every year, sigmoidoscopy every 5 years with FOBT every 3 years, or colonoscopy every 10 years.MMWR. Morbidity and mortality weekly report 06/2012; 61 Suppl:51-6. -
Article: Vignette-based study of ovarian cancer screening: do U.S. physicians report adhering to evidence-based recommendations?
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ABSTRACT: No professional society or group recommends routine ovarian cancer screening, yet physicians' enthusiasm for several cancer screening tests before benefit has been proven suggests that some women may be exposed to potential harms. To provide nationally representative estimates of physicians' reported nonadherence to recommendations against ovarian cancer screening. Cross-sectional survey of physicians offering women's primary care. The 12-page questionnaire contained a woman's annual examination vignette and questions about offers or orders for transvaginal ultrasonography (TVU) and cancer antigen 125 (CA-125). United States. 3200 physicians randomly sampled equally from the 2008 American Medical Association Physician Masterfile lists of family physicians, general internists, and obstetrician-gynecologists; 61.7% responded. After exclusions, 1088 respondents were included; their responses were weighted to represent the specialty distribution of practicing U.S. physicians nationally. Reported nonadherence to screening recommendations (defined as sometimes or almost always ordering screening TVU or CA-125 or both). Twenty-eight percent (95% CI, 24.5% to 32.9%) of physicians reported nonadherence to screening recommendations for women at low risk for ovarian cancer; 65.4% (CI, 61.1% to 69.4%) did so for women at medium risk for ovarian cancer. Six percent (CI, 4.4% to 8.9%) reported routinely ordering or offering ovarian cancer screening for low-risk women, as did 24.0% (CI, 20.5% to 28.0%) for medium-risk women (P ≤ 0.001). Thirty-three percent believed TVU or CA-125 was an effective screening test. In adjusted analysis, actual and physician-perceived patient risk, patient request for ovarian cancer screening, and physician belief that TVU or CA-125 was an effective screening test were the strongest predictors of physician-reported nonadherence to published recommendations. The results are limited by their reliance on survey methods; there may be respondent-nonrespondent bias. One in 3 physicians believed that ovarian cancer screening was effective, despite evidence to the contrary. Substantial proportions of physicians reported routinely offering or ordering ovarian cancer screening, thereby exposing women to the documented risks of these tests. Centers for Disease Control and Prevention and the National Cancer Institute.Annals of internal medicine 02/2012; 156(3):182-94. · 16.73 Impact Factor -
Article: Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians
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ABSTRACT: BACKGROUND:Genetic counseling and testing is recommended for women at high but not average risk of ovarian cancer. National estimates of physician adherence to genetic counseling and testing recommendations are lacking.METHODS:Using a vignette-based study, we surveyed 3200 United States family physicians, general internists, and obstetrician/gynecologists and received 1878 (62%) responses. The questionnaire included an annual examination vignette asking about genetic counseling and testing. The vignette varied patient age, race, insurance status, and ovarian cancer risk. Estimates of physician adherence to genetic counseling and testing recommendations were weighted to the United States primary care physician population. Multivariable logistic regression identified independent patient and physician predictors of adherence.RESULTS:For average-risk women, 71% of physicians self-reported adhering to recommendations against genetic counseling or testing. In multivariable modeling, predictors of adherence against referral/testing included black versus white race (relative risk [RR], 1.16; 95% confidence interval [CI], 1.03-1.31), Medicaid versus private insurance (RR, 1.15; 95% CI, 1.02-1.29), and rural versus urban location. Among high-risk women, 41% of physicians self-reported adhering to recommendations to refer for genetic counseling or testing. Predictors of adherence for referral/testing were younger patient age [35 vs 51 years [RR, 1.78; 95% CI, 1.41-2.24]), physician sex (female vs male [RR, 1.30; 95% CI, 1.07-1.64]), and obstetrician/gynecologist versus family medicine specialty (RR, 1.64; 95% CI, 1.31-2.05). For both average-risk and high-risk women, physician-estimated ovarian cancer risk was the most powerful predictor of recommendation adherence.CONCLUSION:Physicians reported that they would refer many average-risk women and would not refer many high-risk women for genetic counseling/testing. Intervention efforts, including promotion of accurate risk assessment, are needed. Cancer 2011;. © 2011 American Cancer Society.Cancer 11/2011; 117(23):5334 - 5343. · 4.77 Impact Factor
