Physicians with personal connections to cancer more biased against national screening guidelines

Nearly a third of physicians with personal connections to cancer admitted in a recent poll they offer ovarian cancer screening to women at low risk, despite national guidelines warning against the practice.

The research, led by first author Margaret Ragland, MD, and published this week in the Journal of Women’s Health, surveyed 497 primary care physicians in an effort to identify unconscious biases among healthcare providers who act against established guidelines and recommend screening to patients at low risk. Work was funded by the Centers for Disease Control and Prevention, and Ragland’s team found doctors who have either had cancer themselves or been closely affected by the disease are 17 percent more likely than those without personal cancer experience to recommend care that conflicts with national recommendations.

“Most doctors are pretty comfortable with the idea that our personal experience can make a positive impact on our practice—we’ve known someone and so it gives us insight into how to take care of patients in similar circumstances,” Ragland, a pulmonary critical care specialist at CUHealth University of Colorado Hospital in Aurora, Colorado, said in a release. “This study helps us realize that sometimes it can go beyond that.”

Ragland said personal experiences can affect a physician’s practice in many ways, including in recommending tests they perceive as most important. Widely accepted guidelines recommend against ovarian cancer screening in women of even average risk, since the anxiety, cost and possibility of false-positives during that screening can outweigh the “miniscule” chance a doctor will find cancer.

In Ragland et al.’s study, 31.8 percent of primary care physicians with personal cancer experience chose to offer ovarian screening to women, while 14 percent without personal experience offered the same test.

“The reasons that doctors with personal cancer experience may be more likely to not follow screening guidelines are complicated and we don’t know all the answers,” she said. “But my hypothesis is that a doctor’s personal experience may influence their assessment of risk. You see a patient in front of you and may assess the risk to be higher than it actually is.”

This likely stems from availability bias, Ragland said, or the idea that humans tend to judge the frequency of an event by how easily they can recall examples of it. It’s what keeps swimmers out of the water during Shark Week and what keeps Powerball players at the ticket counter when their chances of winning are one in 292,201,338. For physicians, that same bias could keep them recommending a test based on personal experience, regardless of guidelines.

“We’re physicians, but we also have life experiences,” Ragland said. “What this study tells us is that in ways we may not be aware, for better and for worse, our personal experience may affect our practice.”