(155) Identifying Knowledge and Competence Gaps Related to Breast Cancer Screening: A Practice Assessment

Abstract Introduction Breast cancer remains the most frequently diagnosed cancer among women and a leading cause of cancer-related mortality. Early detection through screening mammography has significantly improved outcomes; however, its effectiveness can be limited in women with dense breast tissue. Despite growing awareness requiring breast density notification, variation persists in how clinicians communicate density information, assess risk, and recommend supplemental imaging such as ultrasound, MRI, or contrast-enhanced mammography. These inconsistencies underscore the need to evaluate current screening practices, identify gaps in adherence to evidence-based guidelines, and optimize shared decision-making between patients and providers. Objective To evaluate knowledge and competence among primary care providers and obstetrician-gynecologists related to breast cancer screening-particularly regarding communication of breast density, risk assessment, and use of supplemental imaging-in order to identify gaps in adherence to evidence-based guidelines and opportunities to enhance shared decision-making and improve screening practices. Methods A 25-question, online, continuing medical education (CME) survey was developed, including knowledge and case-based (competence). Respondent confidentiality was maintained, and responses were de-identified and aggregated prior to analyses. The activity launched in August 13, 2024 and data were collected through October 16, 2025. Results The analysis set consisted of primary care providers (n = 204) and obstetricians and gynecologists (n = 79). Analysis showed suboptimal knowledge/competence related to understanding of the latest knowledge related to breast cancer screening practices Specific gaps in knowledge included: • 36% of primary care providers and 67% obstetricians and gynecologists lacked knowledge of breast cancer risk factors • 39% of primary care providers and 29% of obstetricians and gynecologists lacked knowledge of breast cancer risk model for woman who have a mutation in the BRCA1 gene • 17% of primary care providers and 28% of obstetricians and gynecologists lacked knowledge of models to predict breast cancer risk for women with a history of lobular carcinoma in situ (LCIS) • 15% of primary care providers and 30% of obstetricians and gynecologists lacked knowledge of National Comprehensive Cancer Network Guidelines for imaging modalities for annual screenings • 59% of primary care providers and 68% of obstetricians and gynecologists lacked knowledge of American Cancer Society screening recommendations for women ages 45-54 • 17% of primary care providers and 22% of obstetricians and gynecologists lacked competence implementing NCNN screening recommendations for high- risk patient types • 43% of primary care providers and 49% of obstetricians and gynecologists lacked knowledge of the impact of breast sensitivity on mammography sensitivity • 34% of primary care providers and 41% of obstetricians and gynecologists lacked competence identifying correct screening modalities for patients with dense breast who have average/immediate risk for breast cancer • 65% of primary care providers and 66% of obstetricians and gynecologists lacked Knowledge of mammogram reporting FDA standards for a patient with heterogeneously dense breast tissue • 34% of primary care providers and 42% of obstetricians and gynecologists are confident in offering breast cancer screening to patients • 29% of primary care providers and 37% of obstetricians and gynecologists are confident in recommending supplemental screening for patients with dense breast • 67% of primary care providers and 62% of obstetricians and gynecologists always discuss breast cancer screening with patients Conclusions Findings from this assessment reveal substantial and consistent knowledge and competence gaps among both primary care providers and obstetrician–gynecologists in key areas of breast cancer risk assessment and screening-particularly regarding dense breast management, risk modeling, and adherence to guideline-based imaging recommendations. Limited familiarity with NCCN and ACS guidelines, coupled with low confidence in recommending supplemental screening, underscores the need for targeted education to enhance provider understanding, improve risk stratification, and support patient-centered screening decisions. Strengthening clinician competence in these domains is critical to optimizing early detection and reducing missed opportunities for timely diagnosis, especially among women with dense breasts or elevated risk profiles. Disclosure No.