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Quebec breast cancer screening program

A study of the perceptions of physicians in Laval, Que

Diane Larocque, MSc MAP
Regional Coordinator of the Programme québécois de dépistage du cancer du sein at the Laval Health and Social Services Centre.

Daniel Paquette, MD MBA MSc FRCPC and Alejandra Irace-Cima, MD MSc FRCPC
Medical consultants for the Public Health Department of the Laval Health and Social Services Agency.

Correspondence Dr Nguyen, Public Health Department, Laval Health and Social Services Agency, 800 Chomedey Tour A, Laval, QC H7V 3Y4; telephone 450 978-2121; fax 450 978-2100; e-mail nguyet_nguyen{at}ssss.gouv.qc.ca

OBJECTIVE To identify physicians’ perceptions of breast cancer prevention in order to generate strategies to increase women’s participation in the Quebec breast cancer screening program (QBCSP).

DESIGN Qualitative study using archival data and in-depth interviews.

SETTING Laval, Que, a suburban city north of Montreal.

PARTICIPANTS Twenty family physicians and 1 gynecologist practising in Laval who had received at least 1 screening mammography report in 2004 or 2005.

METHODS Archival data were obtained in order to refine our understanding of the QBCSP. In-depth individual interviews were conducted with participating physicians until data saturation was reached in order to determine physicians’ knowledge of, beliefs and attitudes about, and behaviour toward preventive breast cancer practices, as well as their suggestions for enhancing patient compliance. The interviews were recorded, transcribed, and coded, and the content was analyzed.

MAIN FINDINGS Respondents indicated that the screening age groups, the age for beginning clinical breast examination, and the instructions to patients about breast self-examination should be harmonized. Letters to patients should be shortened, simplified, and endorsed by physicians. Screening mammography reports should include more details and be clearer about patient follow-up. The need for patients to sign authorization forms for transmission of information related to their participation in the QBCSP should be reinforced by their physicians. Following abnormal mammogram results, services and procedures should be simplified and delays in appointments decreased. Referral for "orphan patients" (ie, patients without family physicians) should be supervised by nurse practitioners, with physician consultations when needed.

CONCLUSION This study provides a qualitative understanding of improvements or modifications needed in order to reach a screening mammography participation rate sufficient to reduce breast cancer mortality in women.