Breast Cancer Screening Recommendations Amid Changing Guidelines

By Sondra Forsyth

Disagreement persists between professional societies and organizations over the best time to start and to discontinue mammography for breast cancer screening, as well as the optimal amount of time between screenings. A research letter published by JAMA Internal Medicine IN April 2017 examines breast cancer screening recommendations physicians give their patients amid recent guideline changes.

Varying opinions on screening times include:

• Women 45-55: The American Cancer Society (ACS) revised its guidelines in 2015 to encourage personalized screening decisions for women 40 to 44 followed by annual screening starting at age 45 and biennial screening for women 55 or older.
• Women 40-49: The U.S. Preventive Services Task Force (USPSTF) reissued its recommendations in 2016 to recommend personalized screening decisions for women 40 to 49 followed by biennial mammograms for women 50 to 74.
• Women Over 40: The American Congress of Obstetricians and Gynecologists (ACOG) recommends yearly mammograms for women 40 and older.

Archana Radhakrishnan, M.D., M.H.S., of Johns Hopkins University, Baltimore, Md., and coauthors examined physician screening recommendations in a national sample of physicians with a 52 percent response rate among eligible participants (871 of 1,665 physicians). Most of the physicians were family medicine/general practice physicians (44.2 percent), almost 30 percent were internal medicine physicians and 26.1 percent were gynecologists.

Overall, 81 percent of physicians recommended screening to women 40 to 44

Overall, 81 percent of physicians recommended screening to women 40 to 44; 88 percent to women 45 to 49; and 67 percent for women 75 or older. Gynecologists were more likely to recommend screening for women of all ages compared with internal medicine and family medicine/general practice physicians. Among clinicians who recommend screening, most recommend annual examinations, according to the results.

Among the physicians, 26 percent reported trusting ACOG guidelines the most; 23.8 percent the ACS guidelines and 22.9 percent the USPSTF guidelines.

“The results provide an important benchmark as guidelines continue evolving and underscore the need to delineate barriers and facilitators to implementing guidelines in clinical practical,” the article concludes.