Current Perspectives on Physician Barriers to Breast Cancer Screening

Background: Despite reports of rising mammography utilization, breast cancer screening rates still lag behind national recommendations and goals, particularly for older women. This study explores current modifiable physician barriers to screening. Methods: Family physicians and internists on the staff of 10 Long Island community hospitals were surveyed during three successive waves (1988, 1990, 1995) about breast cancer screening behavior. The final survey also assessed current attitudes and level of confidence in screening abilities and beliefs relating to cancer risk and screening of the elderly. Results: The proportion of physicians reporting regularly referring all women aged 50 to 75 years for mammography increased significantly from 37 percent (1988) to 64 percent (1995), while the proportion reporting regularly performing clinical breast examinations remained stable at 56 percent. More than 25 percent of respondents to the 1995 survey were not aware that breast cancer risk increases with aging, and more than one half did not recognize that breast cancer detection by mammography is enhanced in older postmenopausal women. Some physicians reported lack of confidence in aspects of patient counseling, examination, and use of office systems to promote screening. Conclusion: Continuing medical education programs addressing knowledge deficits and perceived physician needs for enhancement of clinical breast examination skills are needed to promote continued improvement in inadequate mammography screening rates.