Article type
Year
Abstract
Introduction/Objective: Although there is evidence that periodic use of mammography is the most effective method for the early detection of breast cancer, studies show that physicians do not always recommend the test to women at risk for the disease. The purpose of this study is to identify women's characteristics associated with physician recommendation of mammography.
Methods: A cross-sectional population survey was conducted in April 1994 in a nationally representative sample of 3218 Spanish women aged 40-70. A questionnaire was used to collect data on the dependent variable (physician recommendation of mammography) and the independent variables (women's characteristics potentially related to physician recommendation). Data were collected on other independent variables: relative wealth index of each Autonomous Community (AC) and breast cancer screening programs in place at the time of the survey. The strength of association between each factor and physician recommendation was estimated using multivariate stepwise logistic regression.
Results: Only 26.3% of all women aged 40-70 said their physician had recommended a mammogram. In the multivariate analysis, physician recommendation was strongly associated with a personal history of breast disease (OR=3.8, 95%CI=2.8-4.9), visiting a gynecologist at least once in the last two years (OR= 2.9, 95%CI= 2.4-3.5), and the intention to be tested (OR= 2.8, 95%CI=2.3-3.4), Less strongly associated (ORs ranging between 2.3 and 1.8) were: living in certain ACs; the belief that one is more susceptible to the disease than other women; living in municipalities with populations <2,000 or >100,000; and believing the test is necessary even when feeling well. Known risk factors for breast cancer, such as direct family history of breast cancer or greater age, were not associated.
Discussion: These results reflect some of the interactions that take place during a physician-patient encounter, which may or may not result in a physician recommending the test. Certain characteristics, such as personal history of breast disease or the intention to be tested, may be associated with a higher motivation to mention breast cancer concerns during the visit. Further studies including these and other factors (physician characteristics, type of visit) are needed to increase physician recommendation, and thus access of women to mammography.
Methods: A cross-sectional population survey was conducted in April 1994 in a nationally representative sample of 3218 Spanish women aged 40-70. A questionnaire was used to collect data on the dependent variable (physician recommendation of mammography) and the independent variables (women's characteristics potentially related to physician recommendation). Data were collected on other independent variables: relative wealth index of each Autonomous Community (AC) and breast cancer screening programs in place at the time of the survey. The strength of association between each factor and physician recommendation was estimated using multivariate stepwise logistic regression.
Results: Only 26.3% of all women aged 40-70 said their physician had recommended a mammogram. In the multivariate analysis, physician recommendation was strongly associated with a personal history of breast disease (OR=3.8, 95%CI=2.8-4.9), visiting a gynecologist at least once in the last two years (OR= 2.9, 95%CI= 2.4-3.5), and the intention to be tested (OR= 2.8, 95%CI=2.3-3.4), Less strongly associated (ORs ranging between 2.3 and 1.8) were: living in certain ACs; the belief that one is more susceptible to the disease than other women; living in municipalities with populations <2,000 or >100,000; and believing the test is necessary even when feeling well. Known risk factors for breast cancer, such as direct family history of breast cancer or greater age, were not associated.
Discussion: These results reflect some of the interactions that take place during a physician-patient encounter, which may or may not result in a physician recommending the test. Certain characteristics, such as personal history of breast disease or the intention to be tested, may be associated with a higher motivation to mention breast cancer concerns during the visit. Further studies including these and other factors (physician characteristics, type of visit) are needed to increase physician recommendation, and thus access of women to mammography.