Dépistage du cancer du sein en médecine libérale : une enquête auprès des généralistes et des gynécologues de Rhône-Alpes

The Professional Union of Private Practitioners in the Rhone-Alps region launched a study in 2002 to investigate the involvement of private practitioners in the breast cancer screening program which has been organized for more than ten years in three administrative districts in this region of France. Similar programs will be started in three other districts soon. The screening practices of 178 general practitioners (GP) and 85 gynecologists (GY) participating in the study were analyzed (5,438 consultations of patients aged 50 to 74 years). Certain physicians participated in five discussion groups, providing complementary qualitative information. Approximately 70% of the patients attending GP consultations and more than 80% attending GY consultations had undergone a mammography in the past 24 months, with a non-significant difference between districts with or without organized screening. Among women who had not had a mammography recently, the majority (78%) were followed regularly and known to be concerned about their health (70%). In routine practice, GPs did not systematically ask their patients about breast screening (1/3 consultations) because of inappropriate reason for consultation, patient already being followed by a gynecologist, intercurrent problem, intellectual level or language difficulties, or excessive workload and noted that 10% of their patients were highly reserved about screening. For the GPs, the organized screening program was an unquestionable step forward (especially in districts where the program had already been started) and complementary to private practice. They pointed out however the negative impact of the administrative aspects and frequently prescribed opportunistic screening. The GYs criticized intrusion into the “doctor-patient” relationship and standardization of practice. They appreciated the new screening protocol but felt the program limited the value of their work. In order to achieve better practitioner involvement, information and education must be improved to respond to the arguments of general practitioners and gynecologists.