Cancer Screening Practices Among Physicians in the National Breast and Cervical Cancer Early Detection Program

Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Journal of Women's Health (Impact Factor: 2.05). 07/2011; 20(10):1479-84. DOI: 10.1089/jwh.2010.2530
Source: PubMed

ABSTRACT The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides low-income, uninsured women with screening and diagnostic services for breast and cervical cancer. Our study was conducted to describe the demographic and practice characteristics of participating and nonparticipating physicians, as well as their beliefs, adoption of new screening technologies, and recommendations for breast and cervical cancer screening.
From a 2006-2007 nationally representative survey, we identified 1,111 practicing primary care physicians who provide breast and cervical cancer screenings and assessed their recommendations using clinical vignettes related to screening initiation, frequency, and cessation. Responses of physicians participating in the NBCCEDP were compared with those from nonparticipating physicians.
Of the physicians surveyed, 15% reported participation in the NBCCEDP, 65% were not participants, and 20% were not sure or did not respond to this question. Program physicians were significantly more likely to practice in multispecialty settings, in a rural location, and in a hospital or clinic setting and had more patients who were female and insured by Medicaid or uninsured compared with nonprogram physicians. Beliefs about the effectiveness of screening tools or procedures in reducing breast or cervical cancer mortality were similar by program participation. Adoption of new technologies, including digital mammography and human papillomavirus (HPV) testing, and making guideline-consistent recommendations for screening initiation, frequency, and cessation did not differ significantly by program participation.
Although there may be differences in physician characteristics and practice settings, the beliefs and screening practices for both breast and cervical cancer are similar between program and nonprogram providers.

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Available from: Mona Saraiya, Jul 25, 2014
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    • "The provider survey was developed specifically for this study, and is based upon national primary care provider surveys [16] [17]. The survey was pilot tested with seven primary care providers in the Atlanta, GA area to estimate respondent burden, format , appropriateness and relevance of survey questions. "
    Cancer Epidemiology Biomarkers & Prevention 11/2014; 23(11 Supplement):A93-A93. DOI:10.1158/1538-7755.DISP13-A93 · 4.13 Impact Factor
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    • "The provider survey was developed specifically for this study, and is based upon national primary care provider surveys [16] [17]. The survey was pilot tested with seven primary care providers in the Atlanta, GA area to estimate respondent burden, format , appropriateness and relevance of survey questions. "
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    ABSTRACT: Introduction: In the United States, Federally Qualified Health Centers (FQHCs) are safety-net clinics that provide cervical cancer screening and human papillomavirus (HPV) vaccination to medically underserved women, some of whom may be at risk for developing cervical cancer. National guidelines recommend against using screening test results or sexual history to determine vaccine eligibility. Documenting HPV vaccine recommendations and beliefs of primary care providers in FQHCs may aid in promoting evidence-based practices and prioritizing health interventions for vulnerable populations. Methods: Between 2009 and 2010, we collected data from 98 primary care providers in 15 FQHC clinics in IL, USA using a cross-sectional survey. Questions assessed provider and practice characteristics, HPV vaccine recommendations, and provider's belief about whether their screening and management procedures would change for women who were vaccinated. Results: 93% of providers recommended the HPV vaccine, most frequently for females aged 13-26 years (98%). Some providers reported sometimes to always using HPV test results (12%), Pap test results (7%), and number of sexual partners (33%) to determine vaccine eligibility. More than half of providers (55%) reported they will not change their screening and management practices for vaccinated females, yet believe vaccination will yield fewer abnormal Pap tests (71%) and referrals for colposcopy (74%). Conclusion: Study providers routinely recommended the HPV vaccine for their patients. However, providers made fewer recommendations to vaccinate females ages 9-12 years (which includes the target age for vaccination) compared to older females, and used pre-vaccination assessments not recommended by U.S. guidelines, such as screening test results and number of sexual partners. In order to maximize the public health benefit of the HPV vaccine to prevent cervical cancer, adherence to guidelines is necessary, especially in settings that provide care to medically underserved women.
    Vaccine 08/2014; 32(42). DOI:10.1016/j.vaccine.2014.07.098 · 3.62 Impact Factor
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    • "Cervical cancer screening practices of providers serving low-income women are consistent with previous studies highlighting slow uptake of the co-test despite positive beliefs and attitudes in the utility of the co-test, and resistance to guideline-consistent screening intervals with normal co-test results (Benard et al., 2011; Holland-Barkis et al., 2006; Roland et al., 2011, 2013; Saraiya et al., 2010; Yabroff et al., 2009). Low encouragement from colleagues, patients and clinic administration for extending the screening intervals, and genuine concerns over losing patients to follow-up and being held accountable for a missed diagnosis may support these results. "
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    ABSTRACT: Objective: Cervical cancer screening using the human papillomavirus (HPV) test and Pap test together (co-testing) is an option for average-risk women ≥ 30 years of age. With normal co-test results, screening intervals can be extended. The study objective is to assess primary care provider practices, beliefs, facilitators and barriers to using the co-test and extending screening intervals among low-income women. Method: Data were collected from 98 providers in 15 Federally Qualified Health Center (FQHC) clinics in Illinois between August 2009 and March 2010 using a cross-sectional survey. Results: 39% of providers reported using the co-test, and 25% would recommend a three-year screening interval for women with normal co-test results. Providers perceived greater encouragement for co-testing than for extending screening intervals with a normal co-test result. Barriers to extending screening intervals included concerns about patients not returning annually for other screening tests (77%), patient concerns about missing cancer (62%), and liability (52%). Conclusion: Among FQHC providers in Illinois, few administered the co-test for screening and recommended appropriate intervals, possibly due to concerns over loss to follow-up and liability. Education regarding harms of too-frequent screening and false positives may be necessary to balance barriers to extending screening intervals.
    Preventive Medicine 04/2013; 57(5). DOI:10.1016/j.ypmed.2013.04.012 · 3.09 Impact Factor
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