Physicians' attitudes and behaviour toward screening mammography in women 40 to 49 years of age.

OBJECTIVE: To determine family physicians' attitudes and behaviour toward screening mammography, breast self-examination, and breast awareness in women aged 40 to 49 at average risk of breast cancer.
DESIGN: Cross-sectional survey.
SETTING: Women's College Hospital and Sunnybrook Health Sciences Centre, both in Toronto, Ont. PARTICIPANTS: Family medicine residents, fellows, and staff physicians at 2 academic family practice health centres affiliated with the University of Toronto (n = 95). MAIN OUTCOME MEASURES: Physicians' answers to questions about offering screening mammography and promoting breast self-examination and breast awareness.
RESULTS: Fifty-two completed surveys were returned (response rate 55%). Less than half of all surveyed family physicians (46%) routinely offered screening mammography to women aged 40 to 49 who were at average risk of breast cancer. Although 40% of physicians did not think breast cancer screening was necessary for women aged 40 to 49, 62% indicated that they would offer screening if their patients requested it. Physicians' reasons not to offer screening included no evidence of decreasing breast cancer deaths (63%), grade A recommendation to screen women starting at age 50 and not at age 40 (25%), and the harms of screening outweighing the benefits (19%). Physicians' reasons to offer screening included patient request (55%), personal clinical practice experience or mentors' recommendations (27%), and guideline recommendations (18%). Breast self-examination was not recommended by most physicians (74%), yet most encouraged women to practise breast awareness (81%).
CONCLUSION: Many women at average risk of breast cancer are not being offered the opportunity to discuss and initiate mammographic screening before 50 years of age. While breast-self examination is not recommended, most physicians promote breast awareness.