Use of the Gail Model and Breast Cancer Preventive Therapy among Three Primary Care Specialties

Background: Breast cancer is an issue of serious concern among women of all ages. The extent to which providers across primary care specialties assess breast cancer risk and discuss chemoprevention is unknown. Methods: Cross-sectional web-based survey completed by 316 physicians in internal medicine (IM), family medicine (FM), and gynecology (GYN) from February to April of 2012. Survey items assessed respondents' frequency of use of the Gail model and chemoprevention, and their attitudes behind practice patterns. Descriptive statistics were used to generate response distributions, and chi-squared tests were used to compare responses among specialties. Results: The response rate was 55.0 % (316/575). Only 40% of providers report having used the Gail model (37% IM, 33% FM, 60% GYN) and 13% report having recommended or prescribed chemoprevention (9% IM, 8% FM, 30% GYN). Among providers who use the Gail model, a minority use it regularly in patients who may be at increased breast cancer risk. Among providers who have prescribed chemoprevention, most have done so five times or fewer. Lack of both time and familiarity were commonly cited barriers to use of the Gail score and chemoprevention. Conclusions: An overall minority of providers, most notably in FM and IM, use the Gail model to assess, and chemoprevention to decrease, breast cancer risk. Until providers are more consistent in their use of the Gail model (or other breast cancer risk calculator) and chemoprevention, opportunities to intervene in women at increased risk will likely continue to be missed.