by Brendon Nafziger
, DOTmed News Associate Editor | February 07, 2012
Greater proportions of obstetricians and gynecologists than family doctors and general internal practitioners report thinking screening mammography is effective in women in their 40s, and say they recommend it to women in this age group, according to a new survey.
OB/GYNs are also more likely to recommend the scans in hypothetical situations where the patient has probably less than 5 years to live, the survey said.
Still, the vast majority of all three specialties report recommending screening mammograms to younger women, according to the study, published Monday in BMC Health Services Research, an online peer-reviewed journal. However, the study was carried out largely before controversial new mammography guidelines were released more than two years ago.
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In the study, researchers with the University of California Davis School of Medicine in Sacramento created an Internet questionnaire that was answered by 684 OB/GYNs, family doctors and internists.
According to the survey, doctors across specialties backed screenings for women aged 50-69, the age group medical consensus suggests derives the most benefit from screenings. But differences among the specialties emerged when they looked at other ages. For women aged 40-49, 94 percent of OB/GYNs said they would "always recommend" screening mammos, compared with 81 percent of internists and 84 percent of family docs.
The differences among the specialists were starker when examining whether they'd recommend screening exams for older women. Eighty-six percent of OB/GYNs said they'd advise patients 70 and over to get the scan, compared with only 67 percent of internal medicine specialists and 59 percent of family practitioners.
And further differences emerged when looking at hypothetical scenarios involving women with not long to live. According to the survey, OB-GYNs were more likely to recommend a mammogram in hypothetical cases in which the life expectancy was less than 5 years: 37 percent of OB-GYNs would recommend a mammogram to such women, compared with 17 percent of internists and 16 percent of family docs. Nonetheless, more than one-third of all respondents said they'd recommend mammography for a 50-year-old woman with unresectable non-small cell lung cancer.
"The propensity of OBG to endorse more aggressive screening may reflect [American Cancer Society] and [American College of Obstetricians and Gynecologists] guidelines, which recommend mammography every one to two years in women from 40 to 50 years of age and annually after age 50 with no specific age for cessation," wrote the study's authors. Shagufta Yasmeen is the corresponding author.
Of note, OB/GYNs also said they were less likely to rate guidelines put out by the U.S. Preventive Services Task Force as "extremely influential." In November 2009, USPSTF roiled the field of radiology by publishing updated guidelines suggesting normal women in their 40s shouldn't get screenings, and that women in their 50s and 60s needed a scan once every other year, instead of annually. However, the researchers said the differences in response by specialty showed up before USPSTF findings actually came out, as the study was conducted from June to December 2009.
The survey was sent to a nationally representative sample of almost 12,000 doctors, and was answered by 271 family docs, 232 general internal medicine docs, 150 OB/GYNs and 31 others, the researchers said.