Do physicians tailor their recommendations for breast cancer risk reduction based on patient's risk?
Do physicians tailor their recommendations for breast cancer risk reduction based on patient's risk?
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DOI：
10.1111/j.1525-1497.2004.30280.x
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发表时间：
2004-04-01
影响因子：
5.7
通讯作者：
Des Jarlais, G
中科院分区：
文献类型：
--
作者：
Haas, JS;Kaplan, CP;Des Jarlais, G
目的：调查医生如何定制他们的乳腺癌预防和降低风险的建议。设计：横断面，邮件调查。参与者：加州初级保健医生随机抽样（N = 822）。测量和主要结果：采用六种标准化的患者情景来评估女性乳腺癌危险因素如何影响医生对乳房x光筛查、生活方式行为咨询、基因检测、他莫昔芬使用、预防性手术和转诊乳腺专家的建议。超过90%的医生支持所有情况下的乳房x光检查。同样，大约80%的医生支持针对所有情况的生活方式因素进行咨询。五年内患乳腺癌的风险和家族史都与这六项建议密切相关。然而，重要的是，医生更倾向于支持对有乳腺癌家族史的女性进行基因检测、使用他莫昔芬和预防性手术的讨论，而不是对那些患乳腺癌风险较高但没有家族史的女性。与内科医生相比，妇产科医生更有可能支持这些做法。结论：乳房x光检查和生活方式行为咨询在乳腺癌预防和降低风险方面得到了医生的广泛认可。虽然医生通常能够根据风险量身定制预防和降低风险的建议，但他们可能没有充分利用遗传评估和更新的治疗方案，为那些患乳腺癌风险高但没有家族史的妇女提供初级预防。
OBJECTIVE: To investigate how physicians tailor their recommendations for breast cancer prevention and risk reduction.DESIGN: Cross-sectional, mail survey.PARTICIPANTS: Random sample of primary care physicians in California (N = 822).MEASUREMENTS AND MAIN RESULTS: Six standardized patient scenarios were used to assess how women's breast cancer risk factors influence physicians' recommendations for screening mammography, counseling about lifestyle behaviors, genetic testing, the use of tamoxifen, prophylactic surgery, and referral to a breast specialist. Over 90% of physicians endorsed mammography for all of the scenarios. Similarly, approximately 80% of physicians endorsed counseling about lifestyle factors for all of the scenarios. Five-year risk of developing breast cancer and family history were both strongly associated with each of the 6 recommendations. Importantly, however, physicians were more likely to endorse the discussion of genetic testing, the use of tamoxifen, and prophylactic surgery for women with a family history of breast cancer compared with women at a higher risk of developing breast cancer but without a family history. Obstetrician-gynecologists were more likely to endorse most of these practices compared with internists.CONCLUSIONS: Mammography and counseling about lifestyle behaviors are widely endorsed by physicians for breast cancer prevention and risk reduction. Whereas physicians are generally able to tailor their recommendations for prevention and risk reduction based on risk, they may perhaps underutilize genetic evaluation and newer therapeutic options for primary prevention for women who are at high risk of developing breast cancer but do not have a family history.