PHYSICIANS REACTIONS TO CHANGE IN RECOMMENDATIONS FOR MAMMOGRAPHY SCREENING

Introduction: In December 1993 the National Cancer Institute (NCI) dec ided to replace its mammography screening guidelines with a Statement of Evidence on Breast Cancer Screening. The Statement of Evidence repr esented a departure from the institute's previous policy of recommendi ng routine mammography screening in women 40-49 and annual screening i n women 50 and over. This study assesses knowledge of and attitudes to ward the Statement of Evidence among primary care physicians. In addit ion, we explore the extent to which physicians changed their individua l clinical policies on mammography screening in response to the Statem ent of Evidence. Methods: Between October 1994 and June 1995, 545 rand omly selected North Carolina primary care physicians completed a maile d questionnaire (overall survey response rate = 42%). Results: Awarene ss of the Statement of Evidence was high (83%), but attitudes toward i t were negative, with a majority of physicians stating that the change in policy was confusing to women and physicians. About 8% of physicia ns who were aware of the Statement of Evidence changed their practice accordingly. Most physicians reported recommending routine mammography screening in women 40-49 and annual screening in women 50 and over. A majority stated they believe scientific evidence supports these pract ices. Conclusions: When faced with a new policy in which guidelines ar e no longer provided and evidence supporting less use of an establishe d technology is conveyed, physicians demonstrated disinclination to ch ange. The impact of changes in recommendations on physician practice i s an important consideration for those who develop and promote screeni ng policies.