PHYSICIAN-REPORTED DETERMINANTS OF SCREENING MAMMOGRAPHY IN OLDER WOMEN - THE IMPACT OF PHYSICIAN AND PRACTICE CHARACTERISTICS

OBJECTIVE: Despite having markedly higher breast cancer risk, complian ce of older women with screening mammography has been poor. This study was undertaken to determine which physician and patient practice char acteristics were associated with high self-reported mammography referr al rates for older women. METHODS: Primary care physicians (n = 129) f rom three socioeconomically diverse communities in Los Angeles were su rveyed. Agreement with annual screening and self-reported referral rat es were assessed for two groups of women, those 65 to 74 years of age and those 75 years and older. Screening outcomes were compared with ph ysician and patient practice characteristics using bivariate and multi variate techniques. RESULTS: Although 73% of physicians agreed with an nual screening of women aged 65 to 74 years, only 24% of physicians re ported actually screening most women seen in this age group. Similarly , 57% of physicians agreed that women age 75 years and older should be screened annually, but only 21% reported recommending mammograms for most women seen in this age group. In multivariate analysis, white phy sicians (adjusted OR = 9.1), younger physicians (adjusted OR = 3.85), and those who used the American Cancer Society's low cost mammography projects (adjusted OR = 5.01) were more likely to report screening the majority of women seen. DISCUSSION: This study suggests that although physicians' intentions to screen older women may be relatively high, a gap exists between intentions and what is reported to be accomplishe d in practice. Race/ethnicity and physician specialty were the two str ongest predictors of high self-reported referral rates, suggesting tha t targeted interventions may be useful.