Table 4.

Clinical Vignette, Corresponding Questions, and Physician Responses

Question and Answer Choice	Patients
	No.	%
Breast cancer surveillance question
In thinking about this patient's medical care, how would you approach breast cancer screening?
You would follow normal guidelines to begin yearly screening with mammogram when she turns 40 years old.	4	1
You would recommend yearly screening with mammograms starting this year.*	263	41
You would recommend every-other-year screening with mammograms starting this year.	94	15
You would recommend yearly screening with breast MRI and mammograms starting this year.*	165	26
You don't know.	118	18
Thyroid surveillance question
You review C.L.'s labs from the past and see that she has undergone yearly thyroid function tests. They have all been normal. What would be your approach to thyroid screening at this time?
Repeat TSH and free T4 and plan to check both yearly.*	497	77
Check TSH only and plan to check yearly.	72	11
Check TSH this year and then discontinue if test is normal.	4	1
Discontinue thyroid function tests, because they have been normal.	23	4
You don't know.	52	8
Cardiac surveillance question
You see that C.L. has undergone an echocardiogram sometime after chemotherapy. The echocardiogram was normal. How would you approach cardiac care for this patient?
You would not proceed with additional testing.	27	4
You would refer her at this time to a cardiologist for evaluation and stress testing.	107	17
You would recommend every-other-year echocardiogram.	365	57
You would recommend yearly echocardiogram.	104	16
You don't know.	37	6

NOTE. Clinical vignette is as follows: C.L. is a 29-year-old female patient treated for Hodgkin's disease when she was 16 years old. She received combination chemotherapy (including cumulative doxorubicin 150 mg/m² and cumulative cyclophosphamide 15 g/m²) and radiation to her chest and neck (mantle radiation, 25 Gy). She recently moved to your area and comes to clinic today for follow-up. She was last seen by a physician more than 1 year ago. Her records regarding cancer treatment, including her doses of radiation and chemotherapy, were faxed to you prior to the visit from the treating institution. You take a full history and do her physical exam. You learn she is feeling well and recently married. Her physical exam was unremarkable.

Abbreviations: MRI, magnetic resonance imaging; TSH, thyroid-stimulating hormone.

^*Denotes correct answer on the basis of Children's Oncology Group Long-Term Follow-Up Guidelines (http://www.survivorshipguidelines.org).