Table 5.
Recommended course of action for vignettes featuring patients at various levels of risk for breast and/or ovarian cancer.†
| Family Medicine n (%) |
Internist n (%) |
OB/GYN n (%) |
Total n (%) |
|
|---|---|---|---|---|
| Patient 1 is 40 years old and has: No personal history of breast cancer; No personal history of DCIS; No personal history of LCIS; and no first-degree relative with breast cancer. | ||||
| Continue routine care. | 202 (80.8%) | 188 (75.2%) | 197 (78.8%) | 587 (78.3%) |
| Order a screening mammogram for this patient.* | 149 (59.6%) | 136 (54.4%) | 196 (78.4%) | 481 (64.1%) |
| Talk with the patient about her lifestyle behaviors. | 110 (44.0%) | 112 (44.8%) | 113 (45.2%) | 335 (44.7%) |
| Discuss the pros and cons of getting genetic testing with this patient.* | 19 (7.6%) | 16 (6.4%) | 5 (2.0%) | 40 (5.3%) |
| Discuss the pros and cons of using a preventive agent with this patient. | 10 (4.0%) | 16 (6.4%) | 7 (2.8%) | 33 (4.4%) |
| Discuss the pros and cons of getting prophylactic surgery with this patient.* | 10 (4.0%) | 14 (5.6%) | 1 (0.4%) | 25 (3.3%) |
| Refer the patient to a specialist. | 14 (5.6%) | 17 (6.8%) | 6 (2.4%) | 37 (4.9%) |
| Patient 2 is 35 years old and has: No personal history of breast cancer; No personal history of DCIS; No personal history of LCIS; One first-degree relative with breast cancer, diagnosed before age 50; and one first-degree relative with ovarian cancer. | ||||
| Continue routine care.* | 116 (46.4%) | 90 (36.0%) | 77 (30.8%) | 283 (37.7%) |
| Order a screening mammogram for this patient. | 146 (58.4%) | 139 (55.6%) | 132 (52.8%) | 417 (55.6%) |
| Talk with the patient about her lifestyle behaviors. | 139 (55.6%) | 124 (49.6%) | 120 (48.0%) | 383 (51.1%) |
| Discuss the pros and cons of getting genetic testing with this patient.* | 168 (67.2%) | 161 (64.4%) | 211 (84.4%) | 540 (72.0%) |
| Discuss the pros and cons of using a preventive agent with this patient. | 44 (17.6%) | 57 (22.8%) | 56 (22.4%) | 157 (20.9%) |
| Discuss the pros and cons of getting prophylactic surgery with this patient. | 33 (13.2%) | 34 (13.6%) | 45 (18.0%) | 112 (14.9%) |
| Refer the patient to a specialist. | 143 (57.2%) | 139 (55.6%) | 126 (50.4%) | 408 (54.4%) |
| Patient 3 is 35 years old and has: No personal history of breast cancer; No personal history of DCIS; No personal history of LCIS; Two first-degree relatives with breast cancer; and was found to carry a pathogenic BRCA1 mutation. | ||||
| Continue routine care.* | 71 (28.4%) | 71 (28.4%) | 45 (18.0%) | 187 (24.9%) |
| Order a screening mammogram for this patient. | 148 (59.2%) | 158 (63.2%) | 165 (66.0%) | 471 (62.8%) |
| Talk with the patient about her lifestyle behaviors. | 117 (46.8%) | 122 (48.8%) | 114 (45.6%) | 353 (47.1%) |
| Discuss the pros and cons of using a preventive agent with this patient.* | 73 (29.2%) | 102 (40.8%) | 132 (52.8%) | 307 (40.9%) |
| Discuss the pros and cons of getting prophylactic surgery with this patient.* | 112 (44.8%) | 122 (48.8%) | 169 (67.2%) | 402 (53.6%) |
| Refer the patient to a specialist. | 207 (82.8%) | 203 (81.2%) | 205 (82.0%) | 615 (82.0%) |
| Patient 4 is 65 years old and has: No personal history of breast cancer; No personal history of DCIS; No personal history of LCIS; No first-degree relatives with breast cancer; and one breast biopsy showing atypical hyperplasia. | ||||
| Continue routine care.* | 127 (50.8%) | 113 (45.2%) | 85 (34.0%) | 325 (43.3%) |
| Order a screening mammogram for this patient. | 181 (72.4%) | 170 (68.0%) | 161 (64.4%) | 512 (68.3%) |
| Talk with the patient about her lifestyle behaviors. | 105 (42.0%) | 109 (43.6%) | 110 (44.0%) | 324 (43.2%) |
| Discuss the pros and cons of getting genetic testing with this patient. | 36 (14.4%) | 46 (18.4%) | 40 (16.0%) | 122 (16.3%) |
| Discuss the pros and cons of using a preventive agent with this patient.* | 36 (14.4%) | 50 (20.0%) | 69 (27.6%) | 155 (20.7%) |
| Discuss the pros and cons of getting prophylactic surgery with this patient. | 21 (8.4%) | 34 (13.6%) | 31 (12.4%) | 86 (11.5%) |
| Refer the patient to a specialist.* | 105 (42.0%) | 121 (48.4%) | 142 (56.8%) | 368 (49.1%) |
†
Responses are not mutually exclusive; respondents could select one or more course of action.
*
Indicates significant difference between provider types (p≤ 0.05)
Grey shading indicates the clinically recommended courses of action.