Physician Perspectives on Mammography Screening for Average-Risk Women: “Like a Double-Edged Sword”

Abstract

Background: On balance, the benefits and harms of mammography screening put systematic screening for average-risk women into question. Since screening decisions frequently occur in primary care, it is important to understand what family physicians think of the evidence on mammography screening, and how they intend to use this information in practice. Methods: Using a cross-sectional design, we obtained data from a group of physician participants who rated the daily Patient-Oriented Evidence that Matters (POEM), which is a short, research-based synopsis. Physicians responded to closed and open-ended questions, based on the validated Information Assessment Method. Quantitative data were assessed with descriptive statistics. The qualitative data were subjected to inductive and deductive iterative thematic analysis. These data were organized into subthemes, and then grouped into major themes. Results: Four relevant POEMs were identified. Each of these POEMs was rated by 1243 to 1351 physicians, and these ratings provided 310 comments. Three major themes emerged across all 4 POEMs: 1) perspectives on information presented in POEMs, 2) applying this information in practice, and 3) confronting clinical and cultural realities. Our findings highlight important differences in the ways physicians value research-based information on mammography screening and use this information in their practice. Conclusions: Although POEMs about mammography screening raise awareness of harms and benefits, deeply rooted ideas illustrate how any change process is complex. In sum, rethinking breast cancer screening for average-risk women is challenging.