Significant differences among physician specialties in management recommendations of BRCA1 mutation carriers.

The National Comprehensive Cancer Network (NCCN) has published guidelines for hereditary breast and ovarian cancer syndrome (HBOCS) management. Little data exist on compliance with these guidelines among different physician specialties. We performed an on-line case-based survey by randomly sampling physicians from five specialties, Family Medicine (FM), Obstetrics and Gynecology (OG), General Surgery (GS), Internal Medicine (IM), and Hematology and Oncology (HO). The physicians (n = 225) were asked to provide HBOCS management of healthy women ages 40-42 in the presence of a familial BRCA1 mutation. For women negative for the BRCA1 mutation, 59% of the physicians recommended appropriate surveillance although with significant differences among specialties; P = 0.01. Using an aggregate screening intensity score, physicians clearly recommended more intense screening for mutation positive than negative women (P < 0.0001), but only 16% of physicians followed NCCN guidelines for BRCA1-positive women. Seventy-six percent of all physicians recommended breast MRI with significant variation among specialties ranging from 62% of FM to 89% of OG (P = 0.0020). Similarly, 63% of physicians recommended prophylactic oophorectomy, with 76 and 78% of GS and OG compared to 38% of IM (P < 0.0001) and 57% recommended prophylactic mastectomy ranging from 84% of HO to 32% of FM (P < 0.0001). Independent of specialty, respondents with BRCA testing experience recommended more intense management than those without; P = 0.021. Management recommendations of BRCA1 mutation carriers are not consistent with NCCN guidelines and vary by medical specialty and genetic testing experience. Targeted education of physicians by specialty is needed, so that optimal management is offered to these high-risk women.

Screening behaviors and long-term compliance with mammography guidelines in a breast cancer screening program.

INTRODUCTION: Screening for breast cancer is generally underused. In an effort to remove common barriers to screening, a free breast cancer screening and education program was created for the employees of a large hospital, incorporating mammography, clinical breast examination (CBE), and breast self-examination (BSE). METHODS: The present study was conducted to evaluate the screening behaviors and long-term compliance of asymptomatic women over age 50 who participated in the program. Data were obtained from questionnaires administered at the time of enrollment (time 1) and annual reenrollment, as well as from radiology records. (Time 2 represents the most recent data.) Long-term compliance with mammography guidelines was measured by calculating a compliance quotient (CQ) for each participant. RESULTS: From time 1 to time 2, subjects significantly increased their use of mammography, CBE, and BSE. At time 2, 89.5% of women had ever received a mammogram, 42.7% had gotten one in the last year, nearly all women (94.6%) had received at least one CBE, 58.0% reported annual CBE, and 44.6% of women practiced monthly BSE. CQ was higher among women who remained in the program longer, were still active in the program at the time of the study, and used screening prior to enrollment. It was also higher in Caucasians and women with a family history of breast cancer. CONCLUSIONS: These results show that a worksite program that eliminates common barriers to screening can significantly increase use of early detection practices. It also demonstrates one method of quantifying long-term compliance with mammography guidelines.

Cancer genetics--survey of primary care physicians' attitudes and practices.

BACKGROUND: Genetic testing for susceptibility to cancer often involves complex medical, ethical, legal, and psychological issues that present a challenge for physicians in clinical practice. METHODS: This study is based on survey data from 101 primary care physicians throughout Texas, measuring their interest in and attitudes about cancer genetics. RESULTS: The majority of physicians surveyed reported that they would consider genetic screening for at least one of seven genetic disorders that predispose to cancer, and almost 20% had made one or more referrals for genetic evaluation and DNA testing. Overall, they wanted to see a variety of continuing education programs and educational materials on DNA testing for cancer susceptibility developed. Although most of the physicians accurately perceived a number of major obstacles to referring patients for genetic testing, barriers such as difficulty in interpreting test results, potential for false-positive and false-negative results, and concern about patients'reactions to test results were reported less frequently. CONCLUSIONS: The results support other evidence for a need to provide continuing education to physicians about genetic testing for susceptibility to cancer.

Screening for breast and prostate cancer: a survey of Texas primary care physicians.

Screening for breast and prostate cancer is underutilized, and according to previous studies, physicians often fail to comply with recommended screening guidelines. We surveyed Texas physicians to determine their screening behaviors and their compliance with National recommendations. For women aged 40 through 49 years, 75.5% of respondents recommend mammography every 1 to 2 years, and 8.4% suggest it annually. For women 50 years and older, 16.1% of clinicians screen every 1 to 2 years, and 81.4% recommend annual mammography. Thus, 71.7% of physicians match or exceed the American Cancer Society guidelines for screening mammography in women 40 years and older. Texas physicians also report a high rate of prostate cancer screening, with more than 90% of respondents offering testing by age 60 years. The screening method preferred by 72.0% of clinicians combines digital rectal examination and the prostate-specific antigen blood test. Overall, the screening practices reported by this sample of Texas physicians compare very favorably with those reported by other groups.

Breast cancer screening behaviors and intentions among asymptomatic women 50 years of age and older.

We examined predictors of (1) compliance with yearly mammography and clinical breast examination (CBE) and (2) intention to obtain mammography and CBE within the following year. Subjects were 312 asymptomatic female hospital employees, 50 years or older, who had participated in a free worksite breast cancer screening program. Mammograms and CBEs had been obtained by 79% and 76% of the subjects, respectively, during the preceding 12 months. The majority of the subjects indicated that they were very/extremely likely to obtain a mammogram and CBE in the next 12 months (88% and 87%, respectively). Multivariate analyses showed that perceived barriers to and physician recommendation of mammography were the strongest predictors of both breast cancer screening behaviors and intentions. Recency of participation in the educational component of the screening program was related to both compliance with mammography in the past 12 months and intention to obtain CBE in the next year. Having a first-degree female relative with a history of breast cancer was related to compliance with CBE in the past 12 months. Perceived efficacy of mammography was related to intention to obtain both mammography and CBE in the next year, and number of reasons for mammography was related to intention to obtain mammography in the next year. Our results suggest that physicians play a key role in motivating women to comply with breast cancer screening and that reducing barriers to obtaining mammography may increase use further.

Skin cancer prevention and early detection intentions and behavior.

This longitudinal study examined predictors of (1) skin cancer prevention and early detection intentions and (2) compliance with recommendation for medical follow-up for suspicious skin lesions. Subjects were 324 hospital employees who were at increased risk for skin cancer and who participated in a worksite skin cancer screening program. Based on behavioral self-regulation theory and the Health Belief Model, multivariate analyses showed that optimism, perceived risk, reasons for doing skin self-examination (SSE), and SSE frequency prior to screening were the best predictors of intentions to engage in future health promotion behaviors (i.e., monthly SSE, regular sunscreen use, and participation in a skin cancer screening program the following year). Although our results also showed that optimism, reasons for doing SSE, and SSE frequency were the best predictors of compliance with medical follow-up, these three variables accounted for only a small amount of the variance in compliance with recommended follow-up care.

Breast cancer screening: racial/ethnic differences in behaviors and beliefs.

Racial/ethnic differences in breast cancer screening behaviors and beliefs were examined in 259 asymptomatic women, 50 years old or older, who participated in a no-cost worksite breast cancer screening program. Hispanics were more likely than African Americans to report having had mammography in the past year. Caucasians and Hispanics were more likely than African Americans to report having had a clinical breast examination in the past year. African Americans to report having had a clinical breast examination in the past year. African Americans and Hispanics were more likely to practice monthly breast self-examination than were Caucasians. African Americans were more likely to report cancer-related fears and worries as barriers to mammography, whereas Caucasians were more likely to report being too busy, inconvenience, and procrastination as barriers. African Americans also were more likely to evaluate their physicians and other health professionals positively than were Caucasians. These results suggest a need to make a special effort to address cancer-related fears as barriers to screening among African Americans, and time-related barriers to screening among Caucasians.

Early detection of skin cancer: racial/ethnic differences in behaviors and attitudes.

Data from 384 individuals participating in a worksite skin cancer screening program were used to assess racial/ethnic differences in attitudes toward and practice of prevention and early detection of skin cancer. Caucasians and Hispanics were more likely than African Americans to report having used a sunscreen during the past year. Caucasians performed skin self-examination more frequently than Hispanics, but African Americans did not differ in their frequency of skin self-examination from the other two groups. African Americans and Hispanics reported that they would be less likely than Caucasians to seek immediate follow-up care for suspicious skin lesions. Both similarities and differences were found in a variety of health belief variables across the three groups. These findings suggest a need for intensified efforts at primary and secondary prevention of skin cancer among African Americans.

Anxiety in medical situations and chemotherapy-related problems among cancer patients.

Relationships between anxiety in medical situations and age, gender, duration of illness, and communication problems with friends or relatives were examined in a heterogeneous sample of 117 adult cancer patients. The relationships between the same demographic, medical, and psychosocial variables and chemotherapy-related problems in a subsample of 79 patients receiving chemotherapy also were examined. Results indicated that females and patients who reported more communication problems with friends or relatives reported more anxiety in medical situations. Female patients and patients who reported more communication problems with friends or relatives also reported more chemotherapy-related problems. Duration of illness was not related significantly to either dependent measure. Clinical implications of these results are discussed.

Skin self-examination in a population at increased risk for skin cancer.

This cross-sectional study examined predictors of skin self-examination (SSE) in a population at increased risk for skin cancer. Subjects were 384 hospital employees participating in a worksite skin cancer screening. Although 61% reported that they performed SSE at least once during the past year, only 20% reported monthly SSE. Only a minority of the subjects were knowledgeable about most of the recommended SSE steps. Based on behavioral self-regulation theory, multivariate analysis showed that a variety of psychological factors (including optimism, knowledge about SSE, perceived self-efficacy, and number of reasons for doing SSE) correlated positively with frequency of SSE. Demographic variables accounted for about 6% of the variance in frequency of SSE. Overall, the variables in this model accounted for about 25% of the variance.

Physical and psychosocial needs of cancer patients.

A collaborative multidisciplinary study was conducted to assess both physical and psychosocial needs of 117 adults with various types of cancers. Although these patients functioned adequately in many areas of their lives, they reported that cancer and its treatment had an impact on energy, physical and recreational activities, communication with spouse, sexual and emotional functioning, occupational matters, and treatment-related situations. Younger patients reported more psychosocial, sexual, and treatment-related problems than did older patients. Female patients reported more chemotherapy-related problems than did male patients. Implications for clinicians treating cancer patients were discussed.

Health family trees: a tool for finding and helping young family members of coronary and cancer prone pedigrees in Texas and Utah.

We report on the feasibility and utility of a new approach for identifying the small percentage of families in the general population with strong familial predisposition to early coronary heart disease, strokes, and common familial cancers (breast, colon, lung), using the "Health Family Tree," a medical family history. A total of 24,332 "trees" were completed by parents and students in 37 high schools in 14 urban and rural communities in Texas and Utah during the years 1980-86. Completed "trees" were obtained from 68 per cent of all enrolled students. High-risk families, included 1,796 families with early coronary disease (7.5 per cent of all student families or 3.7 per cent of their parents' families), 870 stroke families (3.6 per cent), and 415 cancer prone families (1.7 per cent). Among these 3,081 high-risk families there were 8,245 family members already reported to have been diagnosed by a physician to have the familial disease of interest and 43,269 high risk unaffected siblings and offspring of these persons. The average cost per identified high-risk unaffected person was under $10. We conclude that the "Health Family Tree" is a feasible and cost-effective way to find high-risk families.