Time and money are two factors that influence whether a physician will recommend that a woman undergo breast cancer screening, according to a study in Breast Cancer Research & Treatment. A group from Ohio State University in Columbus analyzed data gathered on almost 80,000 women in the U.S. and came up with disparities in the way clinical breast exam (CBE) and mammography are promoted in an outpatient setting.
"The significance of the outpatient treatment setting is that screening recommendations by physicians are given in this setting and, in addition, CBE counseling takes place in an office-based setting.... Physicians are able to provide education ... and discuss the results of mammograms," wrote Dr. Rajesh Balkrishnan and colleagues (Breast Cancer Research and Treatment, September 21, 2006).
For this study, information was obtained from the National Ambulatory Medical Care Survey database. The study population consisted of female patients age 40 and older who visited outpatient-based physicians between 1996 and 2004. The study variables for patients included age, previous breast cancer history, and payment structure. The variables for physicians were specialty (ob/gyn versus non-ob/gyn), geographical practice area, and duration of each patient visit.
According to the results, during the study period physicians performed 198 million CBEs and made 110 million referrals for mammographic screening. The mean age of the women was 61.6 years and 87% were Caucasian.
Patients with private insurance were more likely to be offered a CBE, and had higher odds of being recommended for mammography screening, versus those with public insurance (Medicare, Medicaid), the authors reported. In addition, patients with a past history of breast cancer were more likely to have CBEs, as well as undergo mammography.
"Reimbursement issues for physicians may be a potential explanation for these findings," they explained, adding that previous studies have shown that patients with public insurance were less likely to undergo breast cancer screening.
With regard to time, if a visit with their doctor lasted less than five minutes, these women were less likely to be told about breast cancer screening compared to women whose appointments were as long as 30 minutes. More time was generally devoted to women with co-morbidities, those with a cancer history, and those who had an established relationship with the doctor, the authors stated.
Also, ob/gyns were 13 times more likely to refer an eligible woman for mammography versus other specialists. The authors found this statistic to be particularly noteworthy, "since family/general practitioners and internists tend to be gatekeepers in many insurance plans, it is interesting to note this discrepancy regarding the use of breast cancer screening techniques."
Finally, the authors determined that women in the northeast, south, and western parts of the country had a higher chance of receiving a recommendation for breast cancer screening compared to the Midwest.
By Shalmali Pal
AuntMinnie.com staff writer
December 8, 2006
Related Reading
How old is too old for a mammogram? October 6, 2006
Mammography use in U.S. meets national goals, study shows, June 30, 2005
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