Breast Cancer Coverage from Every Angle

Does Primary Care Appointment Time Affect Breast Cancer Screening Rates?

By: Kayci Reyer
Posted: Wednesday, June 5, 2019

According to research published in JAMA Open Network, primary care clinicians were less likely to order or complete guideline-recommended breast cancer screenings for patients with appointments occurring later in the day. In addition, patients with later appointment times were less likely to have completed the recommended screening within 1 year of the visit.

“We believe that the downward trend of ordering may be the result of ‘decision fatigue,’ where people may be less inclined to consider a new decision after they’ve been making them all day,” noted initial study author Esther Y. Hsiang, BA, of the University of Pennsylvania in a press release from Penn Medicine. “It may also stem from overloaded clinicians getting behind as the day progresses.” Mitesh S. Patel, MD, MBA, MS, also of the University of Pennsylvania, is the senior study author.

The retrospective, multicenter study included 19,254 patients eligible for breast cancer screening between September 1, 2014, and August 31, 2016. Participants with 8:00 AM appointments experienced the highest order rates of 63.7%. The rates decreased to 48.7% by 11:00 AM, jumped to 56.2% at noon, and finally fell to 47.8% at 5:00 PM (adjusted odds ratio [OR] for overall trend = 0.94; P < .001). Similarly, screening test completion rates saw an overall decline, beginning at 33.2% at 8:00 AM and ending at 17.8% at 5:00 PM (adjusted OR = 0.95; P < .001).

The mean age of participants was 60.2 years. All patients included in the study were women. A total of 11,682 participants (60.7%) were white, and 5,495 patients (28.5%) were black. The study also sought to determine the effects of appointment time on colorectal cancer screening rates using a different patient cohort.

Disclosure: The study authors’ disclosure information may be found at

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