Preventive services for breast and cervical cancer in US office-based practices

Background. This study was undertaken to examine patterns of delivery of preventive services for breast and cervical cancer and the bundling of several preventive services. Methods. Data from the National Ambulatory Medical Care Survey on visits by women ages greater than or equal to 45 years to office-based physicians during 1989 and 1990 were analyzed for delivery of clinical breast examination, mammography, breast self-examination counseling, pelvic examination, and Pap smear. Results. An estimated 38.7 million office visits included one or more preventive services for breast and cervical cancer (46.7 visits per 100 women per year). Visits that included clinical breast examination, Pap smear, and mammography together were largely provided by obstetricians and gynecologists, less by general family practice and general internal medicine physicians, and rarely by subspecialists. Twenty-two percent of these visits were periodic preventive visits, lowest for subspecialists and highest for general internists. Major sources of payment included insurance and personal resources at younger ages and Medicare at ages greater than or equal to 65. Conclusions. The periodic preventive visit has received only limited acceptance by physicians who provide preventive care for adult women, Payment for preventive visits changes with age and may affect the appropriate provision of services.