1 Women's Health Unit, Evans Department of Medicine, Section of General Internal Medicine, Boston Medical Center , Boston, Massachusetts.
2 Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, Massachusetts.
J Womens Health (Larchmt). 2018 May;27(5):615-622. doi: 10.1089/jwh.2017.6539. Epub 2018 Jan 17.
Dense breasts on mammography independently increases breast cancer risk and decreases mammography sensitivity. Thirty-two states have adopted notification laws to raise awareness among women with dense breasts about supplemental screening. Little is known about these policies' impact on clinical practice among primary care providers (PCPs).
This study explores PCP attitudes, knowledge, and the impact of the Massachusetts dense breast notification legislation on clinical practice after its enactment in 2015. An anonymous, online survey at two urban safety-net hospitals was administered in 2015-2016. Practicing MDs and nurse practitioners in primary care were invited to participate.
All 145 PCPs in general internal medicine at the two sites were e-mailed a survey link and 80 (55%) were completed. While 64 of 80 PCPs surveyed (80%) had some familiarity with the legislation, none identified the 8 required components of notifications contained in the Massachusetts legislation. Forty-nine percent (39/80) did not feel prepared to respond to patient questions about dense breasts. Forty-one percent (33/80) correctly identified that no current guidelines recommend the use of supplemental screening tests solely based on breast density and 85% (68/80) indicated interest in further training. Female and less experienced providers were more likely to be in favor of the legislation (49% vs. 11% by gender; 76% <5 years vs. 9%> 20 years). Women practitioners (55%) who were more likely than men (17%, p = 0.01) to agree with the policy changed their discussions of mammography results with patients.
PCPs feel underprepared to counsel women about breast density identified on mammography and its implications.
乳腺 X 光摄影中的致密乳腺会独立增加乳腺癌风险并降低乳腺 X 光摄影的敏感度。32 个州已经通过了通知法，以提高致密乳腺女性对补充筛查的认识。关于这些政策对初级保健提供者（PCP）临床实践的影响，知之甚少。
本研究探讨了 PCP 的态度、知识，以及马萨诸塞州致密乳房通知立法在 2015 年颁布后的对临床实践的影响。2015-2016 年，在两家城市安全网医院进行了一项匿名在线调查。邀请初级保健中的执业医师和注册护士参加。
在两个地点的普通内科共有 145 名 PCP 收到了调查链接的电子邮件，其中 80 名（55%）完成了调查。虽然 80 名接受调查的 PCP 中有 64 名（80%）对该立法有一定的了解，但没有人能识别马萨诸塞州立法通知中包含的 8 项必需内容。49%（39/80）表示对回答患者关于致密乳房的问题没有准备。41%（33/80）正确地认为，目前没有指南建议仅根据乳房密度使用补充筛查测试，85%（68/80）表示有兴趣进一步接受培训。女性和经验较少的提供者更倾向于支持该立法（49%比性别 11%；76%<5 年比 9%>20 年）。与男性（17%，p=0.01）相比，更倾向于同意该政策的女性从业者（55%）改变了与患者讨论乳房 X 光检查结果的方式。
PCP 认为自己在向女性患者解释乳腺 X 光摄影中发现的致密乳腺及其影响方面准备不足。
