Corbelli Jennifer, Borrero Sonya, Bonnema Rachel, McNamara Megan, Kraemer Kevin, Rubio Doris, Karpov Irina, McNeil Melissa
1 Division of General Internal Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.
J Womens Health (Larchmt). 2014 Sep;23(9):746-52. doi: 10.1089/jwh.2014.4742. Epub 2014 Aug 12.
Breast cancer is an issue of serious concern among women of all ages. The extent to which providers across primary care specialties assess breast cancer risk and discuss chemoprevention is unknown.
Cross-sectional web-based survey completed by 316 physicians in internal medicine (IM), family medicine (FM), and gynecology (GYN) from February to April of 2012. Survey items assessed respondents' frequency of use of the Gail model and chemoprevention, and their attitudes behind practice patterns. Descriptive statistics were used to generate response distributions, and chi-squared tests were used to compare responses among specialties.
The response rate was 55.0 % (316/575). Only 40% of providers report having used the Gail model (37% IM, 33% FM, 60% GYN) and 13% report having recommended or prescribed chemoprevention (9% IM, 8% FM, 30% GYN). Among providers who use the Gail model, a minority use it regularly in patients who may be at increased breast cancer risk. Among providers who have prescribed chemoprevention, most have done so five times or fewer. Lack of both time and familiarity were commonly cited barriers to use of the Gail score and chemoprevention.
An overall minority of providers, most notably in FM and IM, use the Gail model to assess, and chemoprevention to decrease, breast cancer risk. Until providers are more consistent in their use of the Gail model (or other breast cancer risk calculator) and chemoprevention, opportunities to intervene in women at increased risk will likely continue to be missed.
乳腺癌是所有年龄段女性都严重关注的问题。各初级保健专科的医疗服务提供者评估乳腺癌风险并讨论化学预防的程度尚不清楚。
2012年2月至4月，316名内科（IM）、家庭医学（FM）和妇科（GYN）医生完成了基于网络的横断面调查。调查项目评估了受访者使用盖尔模型和化学预防的频率，以及他们实践模式背后的态度。描述性统计用于生成应答分布，卡方检验用于比较各专科之间的应答。
应答率为55.0%（316/575）。只有40%的医疗服务提供者报告使用过盖尔模型（内科37%，家庭医学33%，妇科60%），13%的医疗服务提供者报告曾推荐或开出处方进行化学预防（内科9%，家庭医学8%，妇科30%）。在使用盖尔模型的医疗服务提供者中，少数人会在乳腺癌风险可能增加的患者中定期使用该模型。在开出处方进行化学预防的医疗服务提供者中，大多数人这样做的次数为五次或更少。时间不足和不熟悉通常被认为是使用盖尔评分和化学预防的障碍。
总体而言，少数医疗服务提供者，尤其是家庭医学和内科的医疗服务提供者，使用盖尔模型进行评估，并使用化学预防来降低乳腺癌风险。在医疗服务提供者更一致地使用盖尔模型（或其他乳腺癌风险计算器）和化学预防之前，干预乳腺癌风险增加女性的机会可能会继续被错过。
