Researchers provide “benchmark” amid changing breast cancer screening guidelines

By Sally Robertson, B.Sc.Apr 12 2017

Different professional organizations and societies continue to disagree over the best time to start and discontinue breast cancer screening, as well as what the optimal interval time should be between mammograms.

A new research letter published in JAMA Internal Medicine has reported on findings from an examination screening recommendations made by physicians amid recent changes to breast screening guidelines.

“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,” wrote Archana Radhakrishnan (Johns Hopkins University, Baltimore, US) and colleagues.

Guidelines from the American Cancer Society (ACS), which were revised in 2015, advises personalized screening decisions for women aged 40 to 44, with subsequent yearly screening from age 45 and biennial screening from age 55. The U.S. Preventive Services Task Force (USPSTF) reissued recommendations in 2016 advising personalized decisions for women aged 40 to 49, with subsequent biennial screening from age 50 to 74. The American Congress of Obstetricians and Gynecologists (ACOG) advises annual screening from age 40 onwards.

Radhakrishnan and colleagues looked at the screening recommendations made in a national sample of physicians, with a response rate of 52% (871 of 1,665 participants). Forty-four percent of physicians worked in family medicine/general practice; 30% in internal medicine and 26% in gynecology.

Overall, 81% recommended screening for women aged 40 to 44; 88% recommended screening between ages 45 to 49 and 67% advised screening from age 75 onwards. Compared with practitioners in family medicine/general practice and internal medicine, gynecologists were more likely to recommend screening at all ages. Among physicians who recommended screening, the majority advised mammography on an annual basis.

In terms of which guidelines were the most trusted, 26% of physicians said they trusted ACOG the most, 23.8% the ACS and 22.9% the USPSTF.

The results provide an “important benchmark” as guidelines continue to change, say the authors.

They also “underscore the need to delineate barriers and facilitators to implementing guidelines in clinical practical," the team concludes.