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Record SM, Thomas SM, Chanenchuk T, Baker JA, Grimm LJ, Plichta JK. Breast Cancer Risk Assessment and Screening Practices Reported Via an Online Survey. Ann Surg Oncol 2023; 30:6219-6229. [PMID: 37460738 PMCID: PMC10528282 DOI: 10.1245/s10434-023-13903-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Breast cancer screening guidelines differ between organizations, and significant variations in practice patterns exist. Previous evidence suggests that provider-level factors are the greatest contributors to risk assessment and screening practice variability. This study aimed to characterize provider factors associated with breast cancer risk assessment and screening practice patterns, and to assess perceived barriers to providing risk assessment. METHODS An online survey was distributed to providers at a single academic institution and to providers publicly via social media (January to August 2022). Respondents in the United States who care for adult women at risk for the development of breast cancer were included. RESULTS Most of the respondents in the 143 completed surveys were white/Caucasian (79%) females (90%) age 50 years or younger (79%), and whereas 97% discuss breast cancer screening with their patients, only 90% order screening mammograms. Risk factor assessment was common (93%), typically performed at the first visit (51%). Additional training in genetics or risk assessment was uncommon (17%), although the majority were interested but did not have the time or resources (55%). Although most (64%) did not perceive barriers to providing risk assessment or appropriate screening, the most common barriers were time (77%) and education (55%). Barriers were more common among family practice or obstetrics and gynecology (OB/GYN) providers and those who worked in an academic setting (all p < 0.05). CONCLUSIONS Breast cancer risk assessment and screening practices are highly variable. Although time is the major barrier to providing risk assessment, providers also need education. Primary care organizations could partner with breast cancer-focused societies for additional resources.
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Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Tori Chanenchuk
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jay A Baker
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Lars J Grimm
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Tanvir I, Hassan A, Alahmadi S, Waseem H, Anwer J, Shafie A, Sheikh MA, Elbasateeny SS, Khosa F. Ethnic and Gender Diversity in Pathology: A Dream Deferred. Cureus 2023; 15:e38528. [PMID: 37288217 PMCID: PMC10241685 DOI: 10.7759/cureus.38528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Background Equity, diversity, and inclusion (EDI) remain an elusive dream in the physician workforce in the United States of America (USA). Many studies have documented the tangible and intangible benefits of EDI, including the caregiver, patients, and healthcare organizations. Objective We aim to examine the ethnic and gender diversity trends of the active residents in pathology in United States residency programs. Methods A retrospective cross-sectional study was conducted on the ethnicity and gender distribution of pathology residency trainees from the academic year 2007-2018. The data was compiled from the American Association of Medical Colleges (AAMC) annual report. Data was entered and analyzed using Microsoft Excel 2013 (Microsoft Corporation, Redmond, WA, USA). Frequencies and percentages were calculated, and bar charts and pie charts were used for graphical representation. Results Almost 35,000 US pathology residents were enrolled according to AAMC during this particular period. The highest trend of enrolling in the field of pathology was observed in 2010 and remained the same for years. This shows that the field of pathology in the USA had some acceptance all these years. The most popular speciality in which most residents were enrolled was anatomic/clinical pathology (80%) in which females were dominant over other fields. Conclusion Over the years, we have failed to overcome gender and ethnicity diversity. Gender and ethnicity have a significant influence on leadership positions, academic ranks, and research productivity among pathology faculty members in the USA.
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Affiliation(s)
- Imrana Tanvir
- Department of Pathology and Laboratory Medicine, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
| | - Amber Hassan
- Translational Neuroscience Lab, CEINGE-Biotecnologie Avanzate, Naples, ITA
- European School of Molecular Medicine, University of Milan, Milan, ITA
| | - Shadi Alahmadi
- Department of Anatomic Pathology, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
| | - Humaira Waseem
- Department of Research, Fatima Jinnah Medical University, Lahore, PAK
| | - Javaria Anwer
- Division of Infectious Diseases, University of Louisville, Louisville, USA
| | - Amer Shafie
- Department of Pathology, King Abdulaziz University, Faculty of Medicine, Rabigh, SAU
| | | | - Samah S Elbasateeny
- Department of Pathology, King Abdulaziz University, Faculty of Medicine, Rabigh, SAU
- Department of Pathology, Zagazig University, Zagazig, EGY
- Department of Pathology, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
| | - Faisal Khosa
- Department of Radiology, Vancouver General Hospital, Vancouver, CAN
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Nadler MB, Corrado AM, Wilson BE, Desnoyers A, Amir E, Ivers N, Desveaux L. Perceived guideline clarity impacts guideline-concordant care for breast cancer screening in women age 40-49. BMC Womens Health 2023; 23:75. [PMID: 36803461 PMCID: PMC9942408 DOI: 10.1186/s12905-023-02190-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/23/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Canadian and US Task Forces recommend against routine mammography screening for women age 40-49 at average breast cancer risk as harms outweigh benefits. Both suggest individualized decisions based on the relative value women place on potential screening benefits and harms. Population-based data reveal variation in primary care professionals (PCPs) mammography rates in this age group after adjusting for sociodemographic factors, highlighting the need to explore PCP screening perspectives and how this informs clinical behaviours. Results from this study will inform interventions that can improve guideline concordant breast screening for this age group. METHODS Qualitative semi-structured interviews were performed with PCPs in Ontario, Canada. Interviews were structured using the theoretical domains framework (TDF) to explore determinants of breast cancer screening best-practice behaviours: (1) risk assessment; (2) discussion regarding benefits and harms; and (3) referral for screening. ANALYSIS Interviews were transcribed and analyzed iteratively until saturation. Transcripts were coded deductively by behaviour and TDF domain. Data that did not fit within a TDF code were coded inductively. The research team met repeatedly to identify potential themes that influenced or were important consequences of the screening behaviours. The themes were tested against further data, disconfirming cases, and different PCP demographics. RESULTS Eighteen physicians were interviewed. The theme of perceived guideline clarity (a lack of clarity on guideline-concordant practices) influenced all behaviours and moderated the extent to which the risk assessment and discussion occurred. Many were unaware of how risk-assessment factored into the guidelines and/or did not perceive that a shared-care discussion was guideline-concordant. Deferral to patient preference (screening referral without a complete discussion of benefits and harms) occurred when the PCPs had low knowledge regarding harms and/or if they experienced regret (TDF domain: emotion) resulting from prior clinical experiences. Older providers described patient's influence impacting their decisions and physicians trained outside Canada, practicing in higher-resourced areas, and female physicians described being influenced by beliefs about consequences of benefits of screening. CONCLUSION Perceived guideline clarity is an important driver of physician behaviour. Improving guideline concordant care should start by clarifying the guideline itself. Thereafter, targeted strategies include building skills in identifying and overcoming emotional factors and communication skills important for evidence-based screening discussions.
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Affiliation(s)
- Michelle B. Nadler
- grid.415224.40000 0001 2150 066XDivision of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON M5G 1Z5 Canada ,grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Ann Marie Corrado
- grid.417199.30000 0004 0474 0188The Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Canada
| | - Brooke E. Wilson
- grid.511274.4Kingston Health Sciences Centre, Kingston, ON Canada
| | | | - Eitan Amir
- grid.415224.40000 0001 2150 066XDivision of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON M5G 1Z5 Canada ,grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Noah Ivers
- grid.417199.30000 0004 0474 0188Women’s College Hospital, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Laura Desveaux
- grid.417199.30000 0004 0474 0188The Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Canada ,grid.417199.30000 0004 0474 0188Women’s College Hospital, Toronto, Canada ,grid.417293.a0000 0004 0459 7334Trillium Health Partners, Toronto, Canada
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Nadler MB, Corrado AM, Desveaux L, Neil-Sztramko SE, Wilson BE, Desnoyers A, Amir E, Ivers N. Determinants of guideline-concordant breast cancer screening by family physicians for women aged 40-49 years: a qualitative analysis. CMAJ Open 2022; 10:E900-E910. [PMID: 36257683 PMCID: PMC9616605 DOI: 10.9778/cmajo.20210266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although the current Canadian Task Force on Preventive Health Care guideline recommends that physicians should inform women aged 40-49 years of the potential benefits and harms of screening mammography to support individualized decisions, previous reports of variation in clinical practice at the physician level suggest a lack of guideline-concordant care. We explored determinants (barriers and facilitators) of guideline-concordant care by family physicians regarding screening mammography in this age group. METHODS We conducted qualitative semi-structured interviews by phone with family physicians in the Greater Toronto Area from January to November 2020. We structured interviews using the Theoretical Domains Framework to explore determinants (barriers and facilitators) of 5 physician screening behaviours, namely risk assessment, discussion regarding benefits and harms, decision or referral for mammography, referral for genetic counselling and referral to high-risk screening programs. Two independent researchers iteratively analyzed interview transcripts and deductively coded for each behaviour by domain to identify key behavioural determinants until saturation was reached. RESULTS We interviewed 18 physicians (mean age 48 yr, 72% self-identified as women). Risk assessment was influenced by physicians' knowledge of risk factors, skills to synthesize risk and beliefs about utility. Physicians had beliefs in their capabilities to have informed patient-centred discussions, but insufficient knowledge regarding the harms of screening. The decision or referral for mammography was affected by emotions related to past patient outcomes, social influences of patients and radiology departments, and knowledge and beliefs about consequences (benefits and harms of screening). Referrals for genetic counselling and to high-risk screening programs were facilitated by their availability and by the knowledge and skills to complete forms. Lack of knowledge regarding which patients qualify and beliefs about consequences were barriers to referral. INTERPRETATION Insufficient knowledge and skills for performance of risk assessment, combined with a tendency to overestimate benefits of screening relative to harms affected provision of guideline-concordant care. These may be effective targets for future interventions to improve guideline-concordant care.
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Affiliation(s)
- Michelle B Nadler
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont.
| | - Ann Marie Corrado
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Laura Desveaux
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Sarah E Neil-Sztramko
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Brooke E Wilson
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Alexandra Desnoyers
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Eitan Amir
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Noah Ivers
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
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