Do Docs Even Follow USPSTF Breast Cancer Screening Guidelines?

April 23, 2015

A presentation at ARRS looked at whether surgeons are really following the USPSTF guidelines.

Most surgeons continue to recommend annual screening mammography for women once they have turned 40 years old, despite current USPSTF guidelines of biennial screening mammography between ages 50 and 74, according to a presentation at the American Roentgen Ray Society 2015 Annual Meeting (ARRS) in Toronto, Canada.

The USPSTF released an updated draft recommendation of guidelines this past week, which remain largely unchanged.

Researchers from Banner MD Anderson Cancer Center in Gilbert, AZ, the VA San Diego Healthcare System, and the University of California San Diego School of Medicine in California, and New York University School of Medicine in NY, sought to determine the screening recommendations that breast surgeons advocate to women of average-risk for developing breast cancer.

Using an anonymous Internet-based survey, open from June 16, 2014 through August 11, 2014, the researchers collected data on the surgeons’ personal and practice backgrounds, their screening mammography, clinical breast examination, and breast self-examination recommendations for patients and family/friends, and their personal screening habits. The surgeons were divided into three cohorts: women who were 40 years old (group 1), women under 40 years old (group 2), and men (group 3). Personal screening questions for group 3 were structured for the surgeon to answer as if he were female.

A total of 288 surveys were completed: 153 (53%) were from breast surgeons and 135 (47%) were general surgeons who performed breast surgery.[[{"type":"media","view_mode":"media_crop","fid":"34511","attributes":{"alt":"Vilert Loving, MD","class":"media-image media-image-right","id":"media_crop_3104131763111","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3678","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Vilert Loving, MD","typeof":"foaf:Image"}}]]

• 88% of breast surgeons and 82% of general surgeons recommend annual mammography for women with an average risk of developing breast cancer.

• 93% reported that they began or would begin annual screenings for themselves at age 40.

• 6% of surgeons recommended the USPSTF guideline to their patients.

• 7% of surgeons recommended the USPSTF guideline for family and friends.

• 88% of group 1 currently do annual mammography.

• 97% of group 2 do or will undergo annual mammography.

• 94% of group 3 would undergo annual mammography.

The 2009 USPSTF recommendations impacted 22% (50/226) of respondents’ screening mammography recommendations for others and 14% (31/227) of respondents’ personal screening behavior, the researchers noted. However, the degree of impact varied from simply opening discussions with patients regarding the utility of screening to switching from annual to biennial screening and initiating tailored risk-based screening.

"We found that the majority of surveyed breast surgeons advocate and personally follow the screening mammography recommendations of the American Cancer Society, the American College of Radiology, and the Society of Breast Imaging, instead of those of the USPSTF," coauthor Vilert Loving, director of breast imaging at the Banner MD Anderson Cancer Center, said in a release.