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Physicians’ Beliefs About Breast Cancer Surveillance Testing are Consistent With Test Overuse

Han, Paul K. J. MD, MA, MPH*,†; Klabunde, Carrie N. PhD; Noone, Anne-Michelle MS§; Earle, Craig C. MD; Ayanian, John Z. MD, MPP; Ganz, Patricia A. MD#; Virgo, Katherine S. PhD, MBA**; Potosky, Arnold L. PhD††

doi: 10.1097/MLR.0b013e31827da908
Original Articles

Background: Overuse of surveillance testing for breast cancer survivors is an important problem but its extent and determinants are incompletely understood. The objectives of this study were to determine the extent to which physicians’ breast cancer surveillance testing beliefs are consistent with test overuse, and to identify factors associated with these beliefs.

Methods: During 2009–2010, a cross-sectional survey of US medical oncologists and primary care physicians (PCPs) was carried out. Physicians responded to a clinical vignette ascertaining beliefs about appropriate breast cancer surveillance testing. Multivariable analyses examined the extent to which test beliefs were consistent with overuse and associated with physician and practice characteristics and physician perceptions, attitudes, and practices.

Results: A total of 1098 medical oncologists and 980 PCPs completed the survey (response rate 57.5%). Eighty-four percent of PCPs [95% confidence interval (CI), 81.4%–86.5%] and 72% of oncologists (95% CI, 69.8%–74.7%) reported beliefs consistent with blood test overuse, whereas 50% of PCPs (95% CI, 47.3%–53.8%) and 27% of oncologists (95% CI, 23.9%–29.3%) reported beliefs consistent with imaging test overuse. Among PCPs, factors associated with these beliefs included smaller practice size, lower patient volume, and practice ownership. Among oncologists, factors included older age, international medical graduate status, lower self-efficacy (confidence in knowledge), and greater perceptions of ambiguity (conflicting expert recommendations) regarding survivorship care.

Conclusions: Beliefs consistent with breast cancer surveillance test overuse are common, greater for PCPs and blood tests than for oncologists and imaging tests, and associated with practice characteristics and perceived self-efficacy and ambiguity about testing. These results suggest modifiable targets for efforts to reduce surveillance test overuse.

Supplemental Digital Content is available in the text.

*Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME

Tufts University School of Medicine, Boston MA

Applied Research Program

§Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD

Ontario Institute for Cancer Research, Toronto, ON, Canada

Department of Health Care Policy, Harvard Medical School, Division of General Medicine, Brigham and Women’s Hospital, Boston, MA

#UCLA Schools of Public Health and Medicine, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA

**Health Services Research Program, Intramural Research Department, American Cancer Society, Atlanta, GA

††Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Support for the Survey of Physicians’ Attitudes Regarding the Care of Cancer Survivors (SPARCCS) was provided by the National Cancer Institute (contract number HSN261200700068C) and the American Cancer Society through its intramural research funds. P.K.J.H. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

The views expressed in this paper do not necessarily represent those of the National Cancer Institute or the American Cancer Society.

The authors declare no conflict of interest.

Reprints: Paul K. J. Han, MD, MA, MPH, Center for Outcomes Research and Evaluation, Maine Medical Center, 590 Forest Avenue, Suite 200, Portland, ME 04101. E-mail:

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