Breast cancer screening practices for women aged 35 to 49 and 70 and older

Nabila Kadaoui; Maryse Guay; Geneviève Baron; José St-Cerny; Jacques Lemaire

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Table 1

List of independent and control variables

FACTORS	CHARACTERISTICS
Physician characteristics
• Predisposing factors	Sociodemographic characteristics -Age -Sex Attitudes and beliefs -Attitudes Personal prevention habits
• Facilitating factors	Training Knowledge Skills Previous clinical experience Logistic factors
• Reinforcing factors	Peer support or social norm Identification of cases
• Organizational factors and health system factors	Consultation setting Type of practice Location of practice Access to services No. of patients
• Situational factors or action triggers	Quick reference guide
Patient characteristics
• Patient factors	Age of patients Motivation Compliance Level of information Previous mammograms Family history of breast cancer

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Table 2

Criteria used to determine adequate breast cancer screening practices, for certain risk categories

RISK CATEGORIES AMONG WOMEN	BREAST CANCER SCREENING PRACTICES
RISK CATEGORIES AMONG WOMEN	REVIEW OF FAMILY HISTORY OF BREAST CANCER	INSTRUCTION IN BREAST SELF-EXAMINATION	CLINICAL BREAST EXAMINATION	PRESCRIBING MAMMOGRAPHY
35–49 y with no risk factors	Yes^*	No^{^†^‡^§}	Yes^\|\|	No^§
35–49 y with risk factors	Yes^*	Yes^*^\|\|	Yes^\|\|	Yes^*^\|\|
≥ 70 y with good life expectancy	No^*	No^{^†^‡^§}	Yes^¶	Yes^¶
≥ 70 y without good life expectancy	No^*	No^{^†^‡^§}	No^*	No^¶

↵* Expert opinion.
↵† Baxter and the Canadian Task Force on Preventive Health Care, 2001.³⁶
↵‡ Society of Obstetricians and Gynaecologists of Canada, 2006.³⁷
↵§ US Preventive Services Task Force, 2009.¹⁹
↵|| National Comprehensive Cancer Network, 2009.²²
↵¶ American Geriatrics Society Clinical Practice Committee, 2005.²¹

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Table 3

Characteristics of participants

VARIABLES MEASURED	*N^ (%)**
Age group (n = 453)
• 20–39 y	98 (21.6)
• 40–59 y	279 (61.6)
• ≥ 60 y	76 (16.8)
Sex (n = 453)
• Male	206 (45.5)
• Female	247 (54.5
Family medicine residency (n = 449)
• Yes	282 (62.8)
• No	167 (37.2)
Years of practice (n = 453)
• 0–9 y	89 (19.6)
• 10–19 y	106 (23.4)
• ≥ 20 y	258 (57.0)
Geographic setting (n = 451)
• Rural	98 (21.7)
• Urban	224 (49.7)
• Semiurban	129 (28.6)
Practice setting^†
• Group practice (n = 452)	265 (58.6)
• Solo practice (n = 451)	39 (8.7)
• Long-term care centre (n = 451)	12 (2.7)
• Hospital (n = 451)	53 (11.7)
• Other (n = 452)	27 (6.0)
Type of practice^†
• Drop-ins and emergency (n = 451)	53 (11.8)
• Consultations with appointments (n = 450)	240 (53.4)
• Other clinical activities (n = 450)	30 (6.6)
• Nonclinical activities (n = 451)	7 (1.6)

↵* For each variable, results are presented for those who responded to the question only.
↵† Defined as being the practice to which the physician dedicates more than 50% of his or her time. Total percentages for each of these 2 variables do not add up to 100% because each practice setting or type of practice is analyzed separately.

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Table 4

Comparison of characteristics of participants who were eligible for the starting sample and the FMOQ population

VARIABLES	*PROPORTION OF ELIGIBLE PARTICIPANTS (N^ = 453)**	PROPORTION OF STARTING SAMPLE (N = 1400)	PROPORTION OF FMOQ POPULATION (N = 8452)	P VALUE^†	P VALUE^‡	P VALUE^§
Age group				.046	.010	.448
• 20–39 y	21.6	18.5	21.6
• 40–59 y	61.6	61.9	59.4
• ≥ 60 y	16.8	19.6	19.0
Sex				.378	.359	.217
• Male	45.5	47.2	48.3
• Female	54.5	52.8	51.7
Years of practice
				.416	.004	.512
• 0–9 y	19.6	18.7	21.8
• 10–19 y	23.4	25.6	23.3
• ≥ 20 y	57.0	55.7	55.0

FMOQ—Fédération des médecins omnipraticiens du Québec.
↵* This number corresponds to the number of individuals who responded to the questions only.
↵† The χ² tests were performed to compare eligible participants to non-participants from the starting sample.
↵‡ The χ² tests were performed to compare the starting sample to the non-sampled FMOQ population.
↵§ The χ² tests were performed to compare eligible participants to non-participants from the FMOQ population. This comparison was deemed useful because statistically significant differences exist between the starting sample and the FMOQ population for the age groups and years of practice.

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Table 5

Frequency of breast cancer screening practices self-reported by physicians according to the risk categories of asymptomatic women of different age groups

RISK CATEGORIES	SELF-REPORTED BREAST CANCER SCREENING PRACTICES^*
RISK CATEGORIES	OFTEN OR ALWAYS REVIEW FAMILY HISTORY OF BREAST CANCER, N (%)	OFTEN OR ALWAYS PROVIDE INSTRUCTION IN BREAST SELF-EXAMINATION, N (%)	OFTEN OR ALWAYS PROVIDE CLINICAL BREAST EXAMINATION, N (%)	OFTEN OR ALWAYS PRESCRIBE MAMMOGRAPHY, N (%)
35–49 y with no risk factors for breast cancer	430 (87.9)	425 (37.6)	430 (83.7)	430 (19.5)
35–49 y with risk factors for breast cancer	422 (93.6)	418 (59.6)	422 (92.2)	422 (81.5)
≥ 70 y with good life expectancy (more than 5 y)	426 (65.0)	424 (20.8)	429 (79.0)	422 (50.7)
≥ 70 y without good life expectancy (less than 5 y)	426 (35.0)	423 (7.1)	430 (47.4)	428 (8.6)

↵* For each practice and risk category, results are presented for physicians who responded to the questions only.

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Table 6

Frequency of referral to genetic counseling for breast cancer self-reported by physicians according to the risk categories of asymptomatic women of different age groups

RISK CATEGORIES	OFTEN OR ALWAYS REFER FOR GENETIC COUNSELING, N (%)^*
35–49 y with no risk factors for breast cancer	427 (2.1)
35–49 y with no familial risk factors for breast cancer	426 (10.1)
35–49 y with familial risk factors for breast cancer	427 (54.3)
≥ 70 y with good life expectancy (more than 5 y)	430 (4.7)
≥ 70 y without good life expectancy (less than 5 y)	426 (1.9)

↵* Results are presented for physicians who responded to the questions only.

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Table 7

Determinants for the practice of prescribing mammography for women 35 to 49 years of age with no risk factors, women 70 years of age and older with a good life expectancy, and women of all ages (correlation and multiple linear regression)

VARIABLE^*	MODEL^† 35–49 Y WITH NO RISK FACTORS (R² = 0.351)		MODEL^‡ ≥ 70 Y WITH GOOD LIFE EXPECTANCY (R² = 0.403)		MODEL TOTAL SCORE PRESCRIPTION MAMMOGRAPHY (R² = 0.263)
VARIABLE^*	SPEARMAN ρ CORRELATION COEFFICIENT	NON-STANDARDIZED REGRESSION COEFFICIENT	SPEARMAN ρ CORRELATION COEFFICIENT	NON-STANDARDIZED REGRESSION COEFFICIENT	SPEARMAN ρ CORRELATION COEFFICIENT	NON-STANDARDIZED REGRESSION COEFFICIENT
Attitude	0.472^§	2.608^§	0.513^§	0.319^§	0.407^§	0.460^§
Screening skills	−0.233^§	−0.351^\|\|	NS	NA	NS	NA
Peer support	NS	NA	0.443^§	0.232^§	0.300^§	0.184^¶
Belief in the efficacy of mammography	−0.441^§	−2.184^§	NS	NA	NS	NA
Knowledge	−0.183^§	−0.238^\|\|	0.160^¶	0.027^¶	NS	NA
No. of patients seen in practice setting	−0.151^¶	−0.392^\|\|	0.121^\|\|	0.035^\|\|	NS	NA
No. of women 35–49 y for PHE	NS	NA	NS	NA	0.110^\|\|	0.019^\|\|
Age of physician	−0.260^§	−0.118^§	NS	0.006^\|\|	−0.163^¶	NS
Sex of physician (woman)^{^**}	NS	NS	^§	0.201^§	^§	NS
Group practice	NS	NA	NS	NA	0.125^\|\|	NA

NA—not applicable, NS—not significant (P > .05), PHE—periodic health examination.
↵* Variables adjusted for the age and sex of physician in the multivariate analysis.
↵† Conversion into new dependent variable = (former dependent variable + 2)².
↵‡ Conversion into new dependent variable = (former dependent variable + 0.8)^−0.7.
↵§ P < .001.
↵|| P < .05.
↵¶ P < .01.
↵** Mann-Whitney test performed bivariately.

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Table 8

Determinants for the practice of prescribing mammography for women 35 to 49 years of age with risk factors and women 70 years of age and older without good life expectancy (correlation and logistic regression)

VARIABLE^*	SPEARMAN RANK CORRELATION COEFFICIENT	LOGISTIC REGRESSION
VARIABLE^*	SPEARMAN RANK CORRELATION COEFFICIENT	OR	CI 95%
Women 35–49 y with risk factors (P < .0001 for the model)
• Attitude	0.354^†	2.262^‡	1.157–4.411
• Skills	0.290^†	1.354^§	1.116–1.663
• Peer support	0.290^†	2.202^‡	1.167–4.142
• Belief in efficacy	0.300^†	2.816^†	1.572–5.162
• No. of women 35–49 y	0.152^§	1.051^‡	1.009–1.097
• Group practice	0.132^§	1.011^‡	1.001–1.021
• Knowledge	0.171^†	NS	NA
• Age of physician	0.102^‡	NS	NA
• Sex of physician^\|\|	NS	NS	NA
Women ≥ 70 y without good life expectancy (P < .0001 for the model)
• Attitude	0.393^†	4.279^†	2.534–7.623
• Skills	−0.232^†	0.783^‡	0.624–0.974
• Nonclinical activities	0.144^§	1.117^‡	1.032–1.260
• Peer support	0.383^†	NS	NA
• Belief in efficacy	−0.247^†	NS	NA
• Knowledge	−0.160^§	NS	NA
• Age of physician	−0.165^§	NS	NA
• Sex of physician^\|\|	NS	NS	NA