Screening for Ovarian Cancer in Low-Risk Women Influenced by Clinician Personal Experience

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Physicians with a personal or family history of cancer were more likely to recommend ovarian cancer screening compared with physicians without this experience.
Physicians with a personal or family history of cancer were more likely to recommend ovarian cancer screening compared with physicians without this experience.

Clinicians with a nonprofessional experience with cancer — such as having cancer themselves or having family members, close friends, or coworkers with cancer — were found to offer nonrecommended ovarian cancer screening to low-risk patients more often than those without these nonprofessional experiences, according to a study published in the Journal of Women's Health.

Researchers deployed a cross-sectional survey to 3200 US primary care clinicians (family medicine, general internal medicine, and obstetrics and gynecology) aged <65 years that examined women's healthcare services; in particular, ovarian cancer screening, diagnosis, and management. The survey included questions regarding physician demographics, practice characteristics, and training, as well as 3 clinical vignettes. The demographic characteristics of the women presented in the vignettes included age (35 or 51 years), race (African American or white), and insurance status (public or private).  The case patients were identified as high risk (paternal grandmother had ovarian cancer, paternal first cousin had premenopausal breast cancer, woman had breast cancer at age 30), medium risk (mother had ovarian cancer at age 62), and low risk (mother had breast cancer at age 70). The questionnaire also indicated whether the case patient requested ovarian cancer screening. The various combination of answers resulted in 48 unique vignettes.

Overall survey response rate was 61.7%, with 591 family physicians, 414 general internists, and 569 obstetrician-gynecologists participating. The majority of clinicians included in the study were men (58.5%), white (71.1%), and practicing in an urban setting (82.0%). The final analysis included data from 497 clinicians who were presented with an annual examination vignette of a woman at low risk of ovarian cancer.     

A total of 69.2% of clinicians with nonprofessional experience with cancer were found to adhere to ovarian cancer screening recommendations vs 86.0% of clinicians without similar cancer experience. Clinicians were more likely to follow screening guidelines for patients who did not specifically request ovarian cancer screening (79.7%) than for patients who requested ovarian cancer screening (63.9%).  Clinicians in group practice were more likely to screen for ovarian cancer according to guidelines (75.8%) than those in solo practice (57.4%). Physicians who adhered to other US Preventive Services Task Force (USPSTF) recommendations were more likely to adhere to guidelines for ovarian cancer screening compared with those who were not strongly influenced by the USPSTF recommendations (79.6% vs 62.7%, respectively).

These findings suggest that “physicians' nonprofessional experiences, in this case with cancer, are associated with clinical practice patterns that can have potential detrimental impacts on patients,” as nonrecommended screening can result in unnecessary and expensive surgery and associated potential complications.

Reference

Ragland M, Trivers KF, Andrilla CHA, et al. Physician nonprofessional cancer experience and ovarian cancer screening practices: results from a national survey of primary care physicians [published online August 10, 2018]. J Womens Health (Larchmt). doi: 10.1089/jwh.2018.6947

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