Physician Breast Cancer Screening Recommendations Following Guideline Changes

Results of a National Survey

Published in: JAMA Internal Medicine, [Epub April 2017]. doi:10.1001/jamainternmed.2017.0453

Posted on RAND.org on May 23, 2017

by Archana Radhakrishnan, Sarah A. Nowak, Andrew M. Parker, Craig Pollack

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Research Questions

  1. Which guidelines for breast cancer screening are physicians more likely to trust after recent changes: those of the U.S. Preventive Services Task Force (USPSTF), the American Congress of Obstetricians and Gynecologists (ACOG), or the American Cancer Society (ACS)?
  2. How consistent are physicians screening recommendations with the guidelines they report trusting most?

Different professional societies and organizations continue to disagree over the optimal time to initiate and discontinue breast cancer screening mammography and the optimal screening interval. In October 2015, the American Cancer Society (ACS) revised its guidelines, encouraging personalized screening decisions for women ages 40 to 44 years followed by annual screening starting at age 45 years and biennial screening for women 55 years or older. The US Preventive Services Task Force (USPSTF) reissued its recommendations in January 2016 recommending personalized screening decisions for women ages 40 to 49 years followed by biennial mammograms for women ages 50 to 74 years. The American Congress of Obstetricians and Gynecologists (ACOG) recommends yearly mammograms for women 40 years or older. With physician recommendations the most important determinant for patients obtaining screening, we investigated physician recommendations in light of recent guideline changes in a national sample.

Key Findings

  • Overall, 26 percent of physicians trusted ACOG guidelines the most; almost 24 percent favored the guidelines of the ACS, and almost 23 percent went with the USPSTF guidelines.
  • Physicians who trusted ACS and ACOG guidelines were more likely to recommend screening to younger women (closer to the age of 40) and older women (those age 75 and older).
  • Primary care physicians and gynecologists were more likely than internal medicine specialists to recommend screening for all age groups.
  • These results provide a benchmark of physician sentiment as guidelines continue to change.

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