Nachtigal Emily, LoConte Noelle K, Kerch Sarah, Zhang Xiao, Parkes Amanda
Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
J Gen Intern Med. 2020 Sep;35(9):2553-2559. doi: 10.1007/s11606-020-05922-y. Epub 2020 Jun 3.
Cancer screening is chiefly performed by primary care providers (PCPs) who rely on organizational screening guidelines. These guidelines provide evidence-based recommendations; however, they are often without unanimity leading to divergent screening recommendations.
Due to the high incidence of breast cancer, the availability of screening methods, and the presence of multiple incongruent guideline recommendations, we sought to understand breast cancer screening practices in Wisconsin to identify patterns that would allow us to improve evidence-based screening adherence.
A 46-question survey on breast cancer screening beliefs and practices for average-risk women was sent to healthcare providers in Wisconsin in 2018, who provided cancer screening services to women. Providers included physicians, nurse practitioners (NPs), physician assistants (PAs), and midwives.
A total of 295 people responded to the survey, for a response rate of 28.6%. Most respondents were physicians (64.1%), followed by NPs (25.7%), PAs (5.3%), and midwives (1.5%). Of physicians, most practiced family medicine (65.3%), followed by internal medicine (25.3%) and gynecology (9.4%). The United States Preventive Services Task Force (USPSTF) was reported as being "very influential" for 60.5% of providers, followed by the American Cancer Society at 46.8%. For patients 40-49 years old, 75.6% of providers performed clinical breast exams and 58.5% recommended self-breast exams; these numbers increased for women 50+ years old to 78.7% and 61.2%, respectively. Mammography was more likely to be recommended annually for women aged 40-49 rather than biennially by non-physician clinicians compared to physicians (p < .001).
PCPs in Wisconsin continue to overestimate the efficacy of clinical and self-breast exams as well as overuse these in clinical practice. Providers find multiple screening guidelines influential but favor the USPSTF; however, these guidelines are frequently not being followed. Further research needs to be done to investigate the lack of national guideline adherence by providers to improve compliance with evidence-based screening recommendations.
癌症筛查主要由依赖组织筛查指南的初级保健提供者（PCP）进行。这些指南提供了基于证据的建议；然而，它们往往缺乏一致性，导致筛查建议存在分歧。
由于乳腺癌的高发病率、筛查方法的可及性以及多个不一致的指南建议的存在，我们试图了解威斯康星州的乳腺癌筛查实践，以确定能够让我们提高基于证据的筛查依从性的模式。
2018年，一项针对平均风险女性乳腺癌筛查信念和实践的包含46个问题的调查问卷被发送给威斯康星州为女性提供癌症筛查服务的医疗保健提供者。提供者包括医生、执业护士（NP）、医师助理（PA）和助产士。
共有295人回复了调查问卷，回复率为28.6%。大多数受访者是医生（64.1%），其次是执业护士（25.7%）、医师助理（5.3%）和助产士（1.5%）。在医生中，大多数从事家庭医学（65.3%），其次是内科（25.3%）和妇科（9.4%）。据报告，美国预防服务工作组（USPSTF）对60.5%的提供者“非常有影响力”，其次是美国癌症协会，为46.8%。对于40 - 49岁的患者，75.6%的提供者进行临床乳腺检查，58.5%的提供者建议进行自我乳腺检查；对于50岁及以上的女性，这些数字分别增至78.7%和61.2%。与医生相比，非医生临床医生更有可能建议40 - 49岁的女性每年进行乳房X线摄影检查，而不是每两年进行一次（p <.001）。
威斯康星州的初级保健提供者继续高估临床乳腺检查和自我乳腺检查功效，并且在临床实践中过度使用这些检查。提供者发现多个筛查指南有影响力，但更倾向于USPSTF；然而，这些指南经常未被遵循。需要进一步开展研究，以调查提供者缺乏对国家指南依从性的情况，从而提高对基于证据的筛查建议的依从性。
