How Physicians Handle Differing Guidelines on Breast Cancer Screening Recommendations

With different professional societies and organizations putting out contrary guidelines for when to start and discontinue breast cancer screening mammography, physicians are letting experiences with patients, family members, and friends with breast cancer to guide decisions.

The study, published in JAMA Internal Medicine, surveyed 871 internal medicine and family medicine/general practice physicians and gynecologists about screening practices, such as if they recommend routine screening for women with no family history of breast cancer and at what intervals they screened. The authors also asked which screening guidelines the physicians trusted the most.

Physicians who knew someone with a poor breast cancer prognosis and who had not been screened were more likely to recommend routine screening for younger and older patients.

“Our findings suggest that we need to help clinicians better understand the impact personal experiences with friends and family members, as well as their patients, have on their practices,” Craig Evan Pollack, MD, MHS, associate professor of medicine at the Johns Hopkins University School of Medicine and the study’s lead author, said in a statement.

American Cancer Society (ACS) encourages personalized screening decisions for women between the ages of 40 and 44 with annual screening starting at age 45 and biennial screening for women age 55 and older. However, the US Preventive Services Task Force recommends personalized screening decisions between the ages of 40 and 49 with biennial mammograms between the ages of 50 and 74. Finally, the American Congress of Obstetricians and Gynecologists (ACOG) recommends mammograms every year, starting when a woman turns 40 years old.

The survey asked respondents to discuss experiences of a patient and a friend or family member diagnosed with breast cancer. The experience was categorized as being diagnosed through screening or not; having a poor prognosis or a good prognosis; or having an unknown screening or prognosis.

The authors found that 81% of physicians recommended screening to women between the ages of 40 and 44, 88% recommended screening for women ages 44 to 49, and 67% recommended it for women age 75 or older. In addition, a majority of physicians recommended annual screening.

The researchers also broke down recommendations based on which guidelines were trusted most. Physicians who trusted the ACS and ACOG most were more likely to recommend screening younger and older women. In general, physicians largely recommended screening to women age 40 and older.

“As a first step toward increasing adherence to guidelines, it may be necessary to create opportunities and messaging strategies that help physicians recognize the experiences that help shape their recommendations,” Pollack said.

In an accompanying editorial, authors from the University of Washington School of Medicine, noted that with widely varying mammography referral rates, physicians need to be aware of their own beliefs around screening. Furthermore, physicians need to be able to discuss with patients the guidelines of the society they trust most in order to facilitate shared decision making.

“Physician adherence to differing sets of guidelines likely influences their patient management, and it is incumbent upon physicians to acknowledge the contribution of their own beliefs on the choices about screening that are ultimately made,” the editorial authors wrote.

Reference

Radhakrishnan A, Nowak SA, Parker AM, Visvanathan K, Pollack CE. Physician breast cancer screening recommendations following guideline changes: results of a national survey. JAMA Intern Med. 2017;177(6):877-878. doi: 10.1001/jamainternmed.2017.0453.