Mammography prescriptions in U.S. primary care setting - are physicians following guidelines?

Background: Breast cancer has the highest incidence rate among women of all races in the U.S. and is the second leading cause of cancer related deaths in women of all racial groups. Evidence shows that screening reduces breast cancer morbidity and mortality; however large proportions of women still do not undergo regular screening. One of the major factors influencing regular screening behavior in women is the physician recommendation for mammograms. The aim of this study was to understand factors that influence physician\u27s prescription for mammogram and to gauge the influence of 2009 U.S Preventive Services Task Force guideline on mammography prescription patterns between 2008 to 2010. Methods: This study used the National Ambulatory Medical Care data. The study sample consisted of women ≥40 years, who had a physician office visit in the US during 2008-2010. Women with current diagnosis of breast cancer were excluded from the study. Bivariate and multiple logistic regressions were used to determine the factors associated with mammography prescription among women. Results: Overall about 29,719 physician office visits were included in our sample and mammography was prescribed during 1361 physician office visits. Majority of the patients receiving mammogram prescriptions were women age 50-64 years, non-Hispanic white, with private insurance. In the multiple regression, the odds of women 50-64 years old who received prescriptions for mammography was approximately twice as compared to 40-49 year old in 2009. The mammography prescription rates were significantly lower for women aged 40-49 years old as compared to 50-64 years in 2009, however there was no difference in prescription by age groups in 2008 and 2010. Results also suggest that physician\u27s prescription of a mammogram is more likely when the physician is a primary care provider to the women, an obstetrician-gynecologist or oncologist and when the practice is not prepaid or HMO type. Women receiving other preventive services like Pap and breast exam, women visiting a physician for routine care, women without diabetes, women diagnosed with obesity and hyperlipidemia, and women with 2 or less previous office visits were more likely to be prescribed a mammogram. Conclusion: We observed a significant drop in mammography prescription rate for women aged 40-49 years as compared to 50-64 years in 2009, with no difference by age groups in 2008 and 2010. Results from this study also suggest that physician specialty, PCP status of physician, type of office setting, nature of visit, number of past visits, recommendation of other screening tests, pre-existing conditions like obesity, diabetes and hyperlipidemia are important determinants of receiving a mammography prescription during a physician office visit. Surprisingly, we found no racial-ethnic disparities, differences by insurance type or regional differences in mammography prescription in our study cohort