Physician-reported Determinants of Screening Mammography in Older Women

Assesses the physician and practice characteristics associated with high self-reported mammography referral rates for older women. Subjects included 129 primary care providers from three socioeconomically diverse communities in Los Angeles. The investigators found that a gap exists between the intention to screen older women and what is accomplished in practice. Although 73 percent of the physicians agreed that women aged 65-74 should receive annual mammography screening, only 24 percent actually reported screening most women seen in this age group. Similarly, 57 percent of physicians agreed that women aged 75 and older should be screened annually, but only 21 percent reported recommending mammograms for most of these women. Multivariate analyses showed that white physicians, younger physicians, those practicing obstetrics/gynecology, or those who used the American Cancer Society's low-cost mammography projects were more likely to report screening the majority of women they saw. Physician race/ethnicity and specialty were the two strongest predictors of high self- reported referral rates, suggesting the benefit of targeted interventions. The rate of mammography screening is one of the indicators selected by the National Commission on Quality Assurance as a marker of quality of care in managed care plans; this study should help these plans improve their screening rates.