Table 5.

Recommended course of action for vignettes featuring patients at various levels of risk for breast and/or ovarian cancera.

Family medicineInternistOB/GYNTotal
n (%)n (%)n (%)n (%)
Patient 1 is 40 years old and has: No personal history of breast cancer; No personal history of DCIS; No personal history of LCIS; and no first-degree relative with breast cancer.
 Continue routine care.202 (80.8%)188 (75.2%)197 (78.8%)587 (78.3%)
 Order a screening mammogram for this patient.b149 (59.6%)136 (54.4%)196 (78.4%)481 (64.1%)
 Talk with the patient about her lifestyle behaviors.110 (44.0%)112 (44.8%)113 (45.2%)335 (44.7%)
 Discuss the pros and cons of getting genetic testing with this patient.b19 (7.6%)16 (6.4%)5 (2.0%)40 (5.3%)
 Discuss the pros and cons of using a preventive agent with this patient.10 (4.0%)16 (6.4%)7 (2.8%)33 (4.4%)
 Discuss the pros and cons of getting prophylactic surgery with this patient.b10 (4.0%)14 (5.6%)1 (0.4%)25 (3.3%)
 Refer the patient to a specialist.14 (5.6%)17 (6.8%)6 (2.4%)37 (4.9%)
Patient 2 is 35 years old and has: No personal history of breast cancer; No personal history of DCIS; No personal history of LCIS; One first-degree relative with breast cancer, diagnosed before age 50; and one first-degree relative with ovarian cancer.
 Continue routine care.b116 (46.4%)90 (36.0%)77 (30.8%)283 (37.7%)
 Order a screening mammogram for this patient.146 (58.4%)139 (55.6%)132 (52.8%)417 (55.6%)
 Talk with the patient about her lifestyle behaviors.139 (55.6%)124 (49.6%)120 (48.0%)383 (51.1%)
 Discuss the pros and cons of getting genetic testing with this patient.b168 (67.2%)161 (64.4%)211 (84.4%)540 (72.0%)
 Discuss the pros and cons of using a preventive agent with this patient.44 (17.6%)57 (22.8%)56 (22.4%)157 (20.9%)
 Discuss the pros and cons of getting prophylactic surgery with this patient.33 (13.2%)34 (13.6%)45 (18.0%)112 (14.9%)
 Refer the patient to a specialist.143 (57.2%)139 (55.6%)126 (50.4%)408 (54.4%)
Patient 3 is 35 years old and has: No personal history of breast cancer; No personal history of DCIS; No personal history of LCIS; Two first-degree relatives with breast cancer; and was found to carry a pathogenic BRCA1 mutation.
 Continue routine care.b71 (28.4%)71 (28.4%)45 (18.0%)187 (24.9%)
 Order a screening mammogram for this patient.148 (59.2%)158 (63.2%)165 (66.0%)471 (62.8%)
 Talk with the patient about her lifestyle behaviors.117 (46.8%)122 (48.8%)114 (45.6%)353 (47.1%)
 Discuss the pros and cons of using a preventive agent with this patient.b73 (29.2%)102 (40.8%)132 (52.8%)307 (40.9%)
 Discuss the pros and cons of getting prophylactic surgery with this patient.b112 (44.8%)122 (48.8%)169 (67.2%)402 (53.6%)
 Refer the patient to a specialist.207 (82.8%)203 (81.2%)205 (82.0%)615 (82.0%)
Patient 4 is 65 years old and has: No personal history of breast cancer; No personal history of DCIS; No personal history of LCIS; No first-degree relatives with breast cancer; and one breast biopsy showing atypical hyperplasia.
 Continue routine care.b127 (50.8%)113 (45.2%)85 (34.0%)325 (43.3%)
 Order a screening mammogram for this patient.181 (72.4%)170 (68.0%)161 (64.4%)512 (68.3%)
 Talk with the patient about her lifestyle behaviors.105 (42.0%)109 (43.6%)110 (44.0%)324 (43.2%)
 Discuss the pros and cons of getting genetic testing with this patient.36 (14.4%)46 (18.4%)40 (16.0%)122 (16.3%)
 Discuss the pros and cons of using a preventive agent with this patient.b36 (14.4%)50 (20.0%)69 (27.6%)155 (20.7%)
 Discuss the pros and cons of getting prophylactic surgery with this patient.21 (8.4%)34 (13.6%)31 (12.4%)86 (11.5%)
 Refer the patient to a specialist.b105 (42.0%)121 (48.4%)142 (56.8%)368 (49.1%)
  • aResponses are not mutually exclusive; respondents could select one or more course of action. Gray shading indicates the clinically recommended courses of action.

  • bIndicates significant difference between provider types (P ≤ 0.05).