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Diffusion of Breast Cancer Risk Assessment in Primary Care

Department of Medicine, School of Medicine (CEG, MS, KA), University of Pennsylvania, Philadelphia
Leonard Davis Institute of Health Economics (CEG, KA), University of Pennsylvania, Philadelphia
Abramson Cancer Center (CEG, KA), University of Pennsylvania, Philadelphia

Correspondence: Corresponding author: Katrina Armstrong, MD, MS, University of Pennsylvania, 1204 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 (E-mail: karmstro{at}mail.med.upenn.edu)

Background: Physicians who provide primary care to women have the opportunity to identify patients at high risk for breast cancer who are candidates for risk reduction strategies. Our objective was to determine the prevalence and determinants of the adoption of breast cancer risk assessment by primary care physicians.

Methods: A cross-sectional survey of a nationally representative random sample of 351 internists, family practitioners, and obstetricians-gynecologists. We used a questionnaire that assessed knowledge, attitudes, discussion of breast cancer risk, use of software to calculate breast cancer risk, and ordering of BRCA1/2 testing.

Results: Eighty-eight percent of physicians reported discussing breast cancer risk at least once during the previous 12 months; 48% had ordered or referred a patient for BRCA1/2 testing; and 18% had used a software program to calculate breast cancer risk. Physicians who had used BRCA1/2 testing or discussed breast cancer risk factors were more likely to be obstetrician-gynecologists and not in a solo practice; the use of risk software was also more common among obstetrician-gynecologists but was also associated with having a family member with breast cancer and a greater knowledge about breast cancer risk. Having patients ask for risk information was associated with the discussion of risk factors but not with the other risk assessment strategies.

Conclusions: Diffusion of breast cancer risk assessment is occurring in primary care practices, with a greater adoption of BRCA1/2 testing than of the use of risk assessment software. Adoption of these strategies seems to be related to the salience of breast cancer personally (for the physician) and within the practice, as well as the size of the practice, rather than attitudes about the risk assessment methods.

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