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Original Research |

Vignette-Based Study of Ovarian Cancer Screening: Do U.S. Physicians Report Adhering to Evidence-Based Recommendations?

Laura-Mae Baldwin, MD, MPH; Katrina F. Trivers, PhD; Barbara Matthews, MBA; C. Holly A. Andrilla, MS; Jacqueline W. Miller, MD; Donna L. Berry, RN, PhD; Denise M. Lishner, MSW; and Barbara A. Goff, MD
[+] Article, Author, and Disclosure Information

From the University of Washington, Seattle, Washington; Centers for Disease Control and Prevention, Atlanta, Georgia; and Dana-Farber Cancer Institute, Boston, Massachusetts.

Disclaimer: The findings and conclusions of this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Acknowledgment: The authors thank Blythe Ryerson from the Centers for Disease Control and Prevention for her early contributions to the development of the study's methods and Gilmore Research Group in Seattle for conducting the survey.

Grant Support: By the Centers for Disease Control and Prevention through the University of Washington Health Promotion Research Centers Cooperative Agreement U48DP001911 and through the Alliance for Reducing Cancer, Northwest, funded by both the Centers for Disease Control and Prevention (grant U48DP001911; V. Taylor, primary investigator) and the National Cancer Institute.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1359.

Reproducible Research Statement:Study protocol: Not available. Statistical code and data set: Available from Dr. Baldwin (e-mail, lmb@uw.edu).

Requests for Single Reprints: Laura-Mae Baldwin, MD, MPH, University of Washington, Department of Family Medicine, Box 354982, Seattle, WA 98195-4982; e-mail, lmb@uw.edu.

Current Author Addresses: Dr. Baldwin, Ms. Andrilla, and Ms. Lishner: University of Washington, Department of Family Medicine, Box 354982, Seattle, WA 98195-4982.

Dr. Trivers: Centers for Disease Control and Prevention, Division of Cancer Protection and Control, 4770 Buford Highway Northeast, MS K55, Atlanta, GA 30341.

Ms. Matthews: University of Washington, 4311 11th Avenue, Suite 210, Seattle, WA 98105.

Dr. Miller: Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, MS K-57, Atlanta, GA 30341.

Dr. Berry: Dana-Farber Cancer Institute, 450 Brookline Avenue, LW518, Boston, MA 02215.

Dr. Goff: University of Washington, Box 356460, Seattle, WA 98105.

Author Contributions: Conception and design: L.M. Baldwin, B. Matthews, C.H.A. Andrilla, J.W. Miller, D.L. Berry, D.M. Lishner, B.A. Goff.

Analysis and interpretation of the data: L.M. Baldwin, K.F. Trivers, B. Matthews, C.H.A. Andrilla, J.W. Miller, D.L. Berry, B.A. Goff.

Drafting of the article: L.M. Baldwin, B. Matthews, C.H.A. Andrilla, B.A. Goff.

Critical revision of the article for important intellectual content: L.M. Baldwin, K.F. Trivers, B. Matthews, C.H.A. Andrilla, J.W. Miller, D.L. Berry, D.M. Lishner, B.A. Goff.

Final approval of the article: L.M. Baldwin, K.F. Trivers, C.H.A. Andrilla, J.W. Miller, D.L. Berry, D.M. Lishner, B.A. Goff.

Statistical expertise: B. Matthews, C.H.A. Andrilla.

Obtaining of funding: L.M. Baldwin, D.L. Berry, B.A. Goff.

Administrative, technical, or logistic support: K.F. Trivers, B. Matthews, D.M. Lishner.

Collection and assembly of data: L.M. Baldwin, B. Matthews, B.A. Goff.

Ann Intern Med. 2012;156(3):182-194. doi:10.7326/0003-4819-156-3-201202070-00006
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This article has been corrected. The original version (PDF) is appended to this article as a supplement.

Background: No professional society or group recommends routine ovarian cancer screening, yet physicians' enthusiasm for several cancer screening tests before benefit has been proven suggests that some women may be exposed to potential harms.

Objective: To provide nationally representative estimates of physicians' reported nonadherence to recommendations against ovarian cancer screening.

Design: Cross-sectional survey of physicians offering women's primary care. The 12-page questionnaire contained a woman's annual examination vignette and questions about offers or orders for transvaginal ultrasonography (TVU) and cancer antigen 125 (CA-125).

Setting: United States.

Participants: 3200 physicians randomly sampled equally from the 2008 American Medical Association Physician Masterfile lists of family physicians, general internists, and obstetrician-gynecologists; 61.7% responded. After exclusions, 1088 respondents were included; their responses were weighted to represent the specialty distribution of practicing U.S. physicians nationally.

Measurements: Reported nonadherence to screening recommendations (defined as sometimes or almost always ordering screening TVU or CA-125 or both).

Results: Twenty-eight percent (95% CI, 24.5% to 32.9%) of physicians reported nonadherence to screening recommendations for women at low risk for ovarian cancer; 65.4% (CI, 61.1% to 69.4%) did so for women at medium risk for ovarian cancer. Six percent (CI, 4.4% to 8.9%) reported routinely ordering or offering ovarian cancer screening for low-risk women, as did 24.0% (CI, 20.5% to 28.0%) for medium-risk women (P ≤ 0.001). Thirty-three percent believed TVU or CA-125 was an effective screening test. In adjusted analysis, actual and physician-perceived patient risk, patient request for ovarian cancer screening, and physician belief that TVU or CA-125 was an effective screening test were the strongest predictors of physician-reported nonadherence to published recommendations.

Limitation: The results are limited by their reliance on survey methods; there may be respondent–nonrespondent bias.

Conclusion: One in 3 physicians believed that ovarian cancer screening was effective, despite evidence to the contrary. Substantial proportions of physicians reported routinely offering or ordering ovarian cancer screening, thereby exposing women to the documented risks of these tests.

Primary Funding Source: Centers for Disease Control and Prevention and the National Cancer Institute.





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