BACKGROUND: Primary care physicians are increasingly the gatekeepers to clinical preventive services including mammography utilization. Moreover, lack of physician recommendation is a major reason for patient failure to obtain screening. A study was designed to examine the attitudes, beliefs, and practices with regard to breast cancer screening as self-reported by primary care physicians. The variables associated with compliance or lack of compliance with screening guidelines are emphasized. METHODS: One hundred sixteen primary care physicians practicing in two New England communities responded to a mailed survey. The survey included questions on attitudes and beliefs about breast cancer screening, as well as questions about perceived barriers and actual screening practices. RESULTS: Fifty-seven percent of the respondents reported ordering annual mammograms for their female patients aged 50 to 75 years. An additional 21 percent reported ordering biannual mammograms for women in this age group. Strongly associated with ordering annual mammograms were beliefs in the benefits of mammography and the perception of community consensus regarding breast cancer screening. A strong positive association of practicing in a group setting and mammography guideline compliance was documented. Middle-aged physicians in solo practice reported the poorest screening compliance. CONCLUSIONS: The level of physician compliance with the standard of annual mammography screening is low (57 percent). The three most important determinants of annual screening suggest ways to improve physician compliance: improve physician attitudes about the benefits of mammography, build further on the medical community's consensus regarding the appropriateness and importance of the annual guidelines, target the poorest compliers with special messages or programs.