The gynecologist's role in mammography screening in absence of a public health program

This study examined the role of the gynecologist in a woman's adoption of mammography screening in a population that does not benefit from an organized program of breast cancer screening. We surveyed 486 women ages 50-69 years, randomly selected from the population of Geneva (Switzerland) about recent mammography use, attitudes toward mammography screening (decisional balance), whether they received a recommendation to undergo mammography from their gynecologist and/or family practitioner, visits to gynecologist and family practitioner, and sociodemographic variables. In multivariate analysis, on-schedule mammography was associated with a recent visit to a gynecologist (odds ratio (OR) 4.8, 95% confidence interval (CI) 2.1-10.9), a gynecologist's recommendation for mammography (OR 15.8, 95% CI 6.5-38.6), a positive attitude toward mammography screening (positive score of decisional balance, OR 1.7, 95% CI 1.0-3.0), and being married (OR 2.0, 95% CI 1.2-3.3). Higher decisional balance scores were associated with a recent visit to a gynecologist ( P=0.001), a gynecologist's recommendation for mammography (P=0.001), and income ( P=0.01). Both a recent visit to a gynecologist and a gynecologist's recommendation for mammography were more frequent in women of higher income. This study suggests that gynecologists--but not family practitioners--play a key role both in referring women for mammography and in fashioning women's perceptions of mammography screening. Our data also indicate that a lack of access to a gynecologist and not receiving a gynecologist's recommendation for mammography may explain why low-income women are less likely to get a screening mammogram.