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医生对乳腺密度的知识、态度和实践。

Physician Knowledge, Attitudes, and Practices Regarding Breast Density.

机构信息

Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, New York.

Rutgers New Jersey Medical School, Newark, New Jersey.

出版信息

J Womens Health (Larchmt). 2019 Sep;28(9):1193-1199. doi: 10.1089/jwh.2018.7429. Epub 2019 May 7.

DOI:10.1089/jwh.2018.7429
PMID:31063441
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6743086/
Abstract

Many states have enacted breast density laws, requiring that women be informed of their breast density status; however there is currently no consensus for screening guidelines or recommendations for women with dense breasts. The objective of this study is to access physician views about breast density and their practices for breast cancer screening of women with dense breasts in light of breast density laws. Setting: Academic medical centers, community and private practices mostly in New York City. Participants: Primary care providers (PCPs), radiologists and gynecologists. Procedure: We conducted the study through anonymous, self-administered surveys about physician knowledge, attitudes, and practices regarding screening of women with dense breasts. Bivariate and multivariate analyses were performed to assess differences between PCPs and specialists. We received 155 responses of which 75% were female, 77% were attending-level physicians, 42% were PCPs, 28% were radiologists, 17% were gynecologists, and 9% other. Almost half of the respondents (48%) were unaware of breast density laws, and two-thirds (67%) felt they needed more education about breast density and supplemental screening. More than half of the respondents (62%) were unaware of the increased risk of breast cancer related to dense breasts. Compared to specialists, PCPs were less aware of their state's breast density laws (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.09-0.50) and of the increased breast cancer risk for women with dense breasts (OR 0.23; 95% CI 0.09-0.60). Breast density laws have not translated into greater knowledge of breast density and recommendations for supplemental screening among PCPs.

摘要

许多州都颁布了乳房密度法,要求告知女性其乳房密度状况;然而,目前对于致密型乳房女性的筛查指南或建议尚无共识。本研究旨在了解医生对乳房密度的看法,以及他们在乳房密度法出台的背景下,对致密型乳房女性进行乳腺癌筛查的做法。

地点

学术医疗中心、社区和私人诊所,主要集中在纽约市。

参与者

初级保健医生(PCP)、放射科医生和妇科医生。

方法

我们通过匿名、自我管理的问卷调查,了解医生对致密型乳房女性筛查的知识、态度和做法。进行了单变量和多变量分析,以评估 PCP 和专科医生之间的差异。

我们共收到 155 份回复,其中 75%为女性,77%为主治医生,42%为 PCP,28%为放射科医生,17%为妇科医生,9%为其他。近一半的受访者(48%)不知道乳房密度法,三分之二(67%)认为他们需要更多关于乳房密度和补充筛查的教育。超过一半的受访者(62%)不知道致密型乳房与乳腺癌风险增加有关。与专科医生相比,PCP 对其所在州的乳房密度法(比值比 [OR] 0.21;95%置信区间 [CI] 0.09-0.50)和致密型乳房女性乳腺癌风险增加(OR 0.23;95%CI 0.09-0.60)的认识较低。

乳房密度法并没有导致 PCP 对乳房密度的认识提高,也没有促使他们推荐进行补充筛查。

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本文引用的文献

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Med Care. 2018 Sep;56(9):798-804. doi: 10.1097/MLR.0000000000000967.
2
Dense Breast Notification Laws: Impact on Downstream Imaging After Screening Mammography.致密型乳腺通知法规:对筛检性乳房 X 光摄影后的下游影像检查的影响。
Med Care Res Rev. 2020 Apr;77(2):143-154. doi: 10.1177/1077558717751941. Epub 2018 Jan 19.
3
Primary Care Provider Experience with Breast Density Legislation in Massachusetts.马萨诸塞州初级保健提供者对乳腺密度立法的体验。
J Womens Health (Larchmt). 2018 May;27(5):615-622. doi: 10.1089/jwh.2017.6539. Epub 2018 Jan 17.
4
Breast screening: What can the interval cancer review teach us? Are we perhaps being a bit too hard on ourselves?乳腺筛查:间期癌复查能给我们带来什么启示?我们是否对自己过于严格了?
Eur J Radiol. 2017 Sep;94:13-15. doi: 10.1016/j.ejrad.2017.07.005. Epub 2017 Jul 12.
5
The effect of volumetric breast density on the risk of screen-detected and interval breast cancers: a cohort study.乳腺体积密度对筛查发现的乳腺癌和间期乳腺癌风险的影响:一项队列研究。
Breast Cancer Res. 2017 Jun 5;19(1):67. doi: 10.1186/s13058-017-0859-9.
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Dense Breast Legislation in the United States: State of the States.美国致密乳腺相关立法:各州情况
J Am Coll Radiol. 2016 Nov;13(11S):R53-R57. doi: 10.1016/j.jacr.2016.09.027.
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Content, Readability, and Understandability of Dense Breast Notifications by State.按州划分的致密乳腺通知的内容、可读性和可理解性。
JAMA. 2016 Apr 26;315(16):1786-8. doi: 10.1001/jama.2016.1712.
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Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement.乳腺癌筛查:美国预防服务工作组推荐声明。
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Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.平均风险女性的乳腺癌筛查:美国癌症协会2015年指南更新
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Breast cancer screening in the era of density notification legislation: summary of 2014 Massachusetts experience and suggestion of an evidence-based management algorithm by multi-disciplinary expert panel.乳腺密度告知立法时代的乳腺癌筛查:2014年马萨诸塞州经验总结及多学科专家小组基于证据的管理算法建议
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